title: Tumor recurrence after liver transplantation for hepatocellular carcinoma: recurrence pathway and prognostic factors.
abstract: BACKGROUND
  Liver transplantation (OLT) has been advocated as a good management option for patients with carcinoma hepatocellular (HCC). More recurrences are extrahepatic due to many pathological factors.
  
  
  METHODS
  From April 1986 to December 2003, we performed 95. OLTs for HCC including 73% men of mean age of 54.7 years and 25.3% not filling Mazzaferro's criteria.
  
  
  RESULTS
  The recurrence incidence was 15.8% (n = 15), including only extrahepatic lesions in 11 (mainly lung recurrence, seven) and hepatic plus extrahepatic in four. Main late mortality was due to tumor recurrence (n = 12, 33.3%). No differences were observed among sex, preoperative chemoembolization, age, Child, Okuda, etiology, or satellite nodules. A greater incidence of tumor recurrence was observed with a preoperative biopsy (45.5% vs 5.9%, P = .0001); and alpha fetoprotein (AFP) > 200 ng/mL (37.5% vs 13.3%, P = .08); known HCC (25.5% vs 3.1%, P = .008); vascular invasion (42.1% vs 10.3%, P = .001); > 5 cm single nodule (50% vs 13%, P = .004); more than three nodules (50% vs 13.9%, P = .01); moderately to poorly differentiated tumors (37.5% vs 12.7%, P = .01); pTNM IV (50% vs 8.7%, P = .0001); and not meeting Milan criteria (40.9% vs 9.2%, P = .001). These are the same factors for extrahepatic recurrence. For hepatic recurrence the prognostic factors were: vascular invasion (15.8% vs 1.5%, P = .008), more than three nodules (25% vs 2.5%, P = .004), moderately to poorly differentiated tumors (18.8% vs 1.4%, P = .003), pTNM IV (16.7% vs 1.4%, P = .006), and not meeting Milan criteria (13.6% vs 1.5%, P = .01).
  
  
  CONCLUSIONS
  Recurrence incidence with Milan criteria was less than 10%, mainly extrahepatic (lung). Prognostic factors for tumor recurrence were pathological features, namely vascular invasion, more than three nodules, size larger than 5 cm, moderately to poorly differentiated tumors, pTNM IV stage. The use of preoperative chemoembolization did not decrease the recurrence rate. A preoperative biopsy increased the incidence of extrahepatic recurrence.
authors: General, Digestive and Abdominal Organs Transplantation Surgical Department, 12 de Octubre Hospital, Madrid, Spain. perezsb@hotmail.com
authors: B
authors: B
authors: Pérez-Saborido
authors: S Jiménez
authors: SJ
authors: de los Galanes
authors: J C
authors: JC
authors: Menéu-Díaz
authors: C Jiménez
authors: CJ
authors: Romero
authors: A Moreno
authors: AM
authors: Elola-Olaso
authors: Y Fundora
authors: YF
authors: Suárez
authors: V Barra
authors: VB
authors: Valencia
authors: E
authors: E
authors: Moreno-González
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D008113:Liver Neoplasms / Q000601:surgery*; D016031:Liver Transplantation / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology* / Q000473:pathology; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors