[Influence of treatment of hepatocellular carcinoma before liver transplantation on post transplant tumor recurrence and survival].
OBJECTIVE
To evaluate the effectiveness of treatment of hepatocellular carcinoma (HCC) before liver transplantation (LT) and its influence on survival and tumor recurrence in patients transplanted for HCC.


METHODS
We included 67 liver transplant patients with a preoperative diagnosis of HCC and pathological confirmation in the native liver between January 2000 and October 2007. Treatment before LT was performed in 46 (68.7%) patients [radiofrequency ablation in 18, transarterial chemoembolization in 31 and percutaneous ethanol injection in two].


RESULTS
The median time between inclusion on the waiting list and LT was 4 months and was similar in treated and untreated patients. The median time between pre-transplantation locoregional therapy and LT was less than 6 months in 65.2% of the patients. Treated patients had better liver function (Child A 52.2 vs 19%; Child B 39.1 vs 33.3%; Child C 8.7 vs. 47.6%; p=0.001) and a higher proportion of total tumor size > 3 cm (59.1% vs 30%; p=0.031). Total tumor necrosis was observed in 26.1% of the patients, with no differences according to treatment modality or tumor size. Tumor recurrence occurred in six patients (9%). The median time between LT and tumor recurrence was 26.5 months with a subsequent median survival of 6.6 months. Overall survival was 83.5%, 69.9% and 59.5%, and tumor recurrence-free survival was 83.5%, 68.3% and 58% at 1, 3 and 5 years, respectively. Previous HCC treatment showed no influence on survival or tumor recurrence. Likewise, the grade of tumor necrosis was unrelated to overall survival or the probability of recurrence.


CONCLUSIONS
Treatment of HCC before LT in patients with a waiting list time of less than 6 months does not appear to influence survival or tumor recurrence.
Díaz-Sánchez
Antonio
A
Sección de Hepatología, CIBEREHD, Servicio de Aparato Digestivo, Hospital General Universitario Gregorio Marañón, Madrid, España. antoniodisan@yahoo.es
Matilla
Ana
A
Núñez
Oscar
O
Merino
Beatriz
B
Peligros
Isabel
I
Rincón
Diego
D
Salcedo
Magdalena
M
Lo Iacono
Oreste
O
Vega Catalina
María
M
Clemente
Gerardo
G
Bañares
Rafael
R
D000970:Antineoplastic Agents / Q000627:therapeutic use; D006528:Carcinoma, Hepatocellular / Q000098:blood supply / Q000175:diagnosis / Q000401:mortality / Q000556:secondary / Q000601:surgery / Q000628:therapy*; D017115:Catheter Ablation; D016461:Chemoembolization, Therapeutic; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage / Q000627:therapeutic use; D004621:Embolization, Therapeutic; D005260:Female; D006498:Hepatectomy; D006801:Humans; D007459:Iodized Oil / Q000008:administration & dosage; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000098:blood supply / Q000175:diagnosis / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D011446:Prospective Studies; D012008:Recurrence; D016019:Survival Analysis
D000970:Antineoplastic Agents; D007459:Iodized Oil; D004317:Doxorubicin