Meta-analysis of tumor recurrence after liver transplantation for hepatocellular carcinoma based on 1,198 cases.
BACKGROUND
The purpose of this study was to systematically review tumor characteristics leading to recurrence of hepatocellular carcinoma (HCC) after liver transplantation (LT).


METHODS
A computer search of the Medline database was carried out. Tumor characteristics examined were: 1) no vascular versus vascular invasion, 2) solitary versus multifocal tumors, 3) well differentiated versus not well differentiated HCCs, 4) HCC meeting versus HCC exceeding the Milan criteria, 5) HCC < or =5 cm versus HCC>5 cm.


RESULTS
Of 45 clinical studies screened, 9 fulfilled the study criteria. These studies included from 21 to 316 patients, for a total of 1198 patients. A fixed effects model was applied. A significant correlation between vascular invasion, not well differentiated HCC, tumor size >5 cm, HCC exceeding the Milan criteria, and HCC recurrence post transplant was shown (common odds ratio of 8.727, 2.89, 13.32 and 4.205, respectively). Heterogeneity for the parameter solitary versus multifocal tumor was shown.


CONCLUSIONS
High risk pathology for HCC recurrence is characterized by not well differentiated tumors and by HCCs that exceed the Milan criteria. A clinical application of these data may be a scoring system which includes the tumor grading in the evaluation and listing of HCC patients to LT.
Sotiropoulos
Georgios C
GC
Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Hufelandstr. 55, 45122 Essen, Germany. Georgios.sotiropoulos@uni-essen.de
Molmenti
E P
EP
Lösch
C
C
Beckebaum
S
S
Broelsch
C E
CE
Lang
H
H
D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery; D016031:Liver Transplantation; D009364:Neoplasm Recurrence, Local; D016017:Odds Ratio; D012189:Retrospective Studies