title: Prognostic factors for tumor recurrence after a 12-year, single-center experience of liver transplantations in patients with hepatocellular carcinoma.
abstract: Background. Factors affecting outcomes after orthotopic liver transplantation (OLT) for hepatocellular carcinoma (HCC) have been extensively studied, but some of them have only recently been discovered or reassessed. Methods. We analyzed classical and more recently emerging variables with a hypothetical impact on recurrence-free survival (RFS) in a single-center series of 283 patients transplanted for HCC between 1997 and 2009. Results. Five-year patient survival and RFS were 75% and 86%, respectively. Thirty-four (12%) patients had HCC recurrence. Elevated preoperative alpha-fetoprotein (AFP) levels, preoperative treatments of HCC, unfulfilled Milan and up-to-seven criteria at final histology, poor tumor differentiation, and tumor microvascular invasion negatively affected RFS by univariate analysis. Milan and up-to-seven criteria applied preoperatively, and the use of m-TOR inhibitors did not reach statistical significance. Cox's proportional hazard model showed that only elevated AFP levels (Odds Ratio = 2.88; 95% C.I. = 1.43-5.80; P = .003), preoperative tumor treatments (Odds Ratio = 4.84; 95% C.I. = 1.42-16.42; P = .01), and microvascular invasion (Odds Ratio = 4.82; 95% C.I. = 1.87-12.41; P = .001) were predictors of lower RFS. Conclusions. Biological aggressiveness and preoperative tumor treatment, rather than traditional and expanded dimensional criteria, conditioned the outcomes in patients transplanted for HCC.
authors.affiliation: General Surgery and Transplant Unit, Department of General Surgery and Organ Transplantation, University of Bologna, 40138 Bologna, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Cescon
authors.forename: Matteo
authors.initials: M
authors.lastname: Ravaioli
authors.forename: Gian Luca
authors.initials: GL
authors.lastname: Grazi
authors.forename: Giorgio
authors.initials: G
authors.lastname: Ercolani
authors.forename: Alessandro
authors.initials: A
authors.lastname: Cucchetti
authors.forename: Valentina
authors.initials: V
authors.lastname: Bertuzzo
authors.forename: Gaetano
authors.initials: G
authors.lastname: Vetrone
authors.forename: Massimo
authors.initials: M
authors.lastname: Del Gaudio
authors.forename: Marco
authors.initials: M
authors.lastname: Vivarelli
authors.forename: Antonietta
authors.initials: A
authors.lastname: D'Errico-Grigioni
authors.forename: Alessandro
authors.initials: A
authors.lastname: Dazzi
authors.forename: Paolo
authors.initials: P
authors.lastname: Di Gioia
authors.forename: Augusto
authors.initials: A
authors.lastname: Lauro
authors.forename: Antonio Daniele
authors.initials: AD
authors.lastname: Pinna