title: Prognostic factors for hepatocellular carcinoma recurrence: experience with 83 liver transplantation patients.
abstract: BACKGROUND
  Orthotopic liver transplantation (OLT) is a rational therapeutic option for early-stage hepatocellular carcinoma (HCC) providing a potential cure and improving survival.
  
  
  METHODS
  This retrospective study of a longitudinal cohort used an electronic database collected prospectively from September 1997 to May 2010. The variables were gender, age (years), and alpha-fetoprotein (AFP) level (ng/mL). In explanted livers we observed: microvascular or macrovascular invasion, number of nodules and their largest size, Edmondson-Steiner histological differentiation, incidental tumor transarterial chemoembolization (TACE), Milan criteria, and previous down-staging.
  
  
  RESULTS
  Five of 83 (6.0%) subjects including 68 (82%) males with a mean time to diagnosis of 9 months experienced tumor relapses. Mean patient age at HCC recurrence was 55.3 years for male and 44.6 years for female subjects. Vascular invasion was detected in 17/83 (20.5%) subjects, namely 2% of macrovascular invasion, and 52.5% with expanded Milan criteria due to an increased number and size of nodules in the explanted livers. An incidental tumor was observed in 29.5% of cases. Preoperative TACE treatment was performed in 13 (15.6%) patients. None of the patients who had a HCC recurrence had undergone TACE. AFP level at the time of recurrence was around 1,900 ng/mL. The predictive factor for mortality was nodule size (P=.04; hazard ratio=0.0269; confidence interval [CI], 95% 0.0094-0.299).
  
  
  CONCLUSIONS
  Patients with relapses showed the worst survival and tumor size was a predictive factor for recurrence.
authors.affiliation: Faculty of Medical Sciences, State University of Campinas, Campinas, Brazil.
authors.forename: E C
authors.initials: EC
authors.lastname: Ataide
authors.forename: I F S F
authors.initials: IF
authors.lastname: Boin
authors.forename: J R S
authors.initials: JR
authors.lastname: Almeida
authors.forename: T
authors.initials: T
authors.lastname: Sevá-Pereira
authors.forename: R S B
authors.initials: RS
authors.lastname: Stucchi
authors.forename: A R
authors.initials: AR
authors.lastname: Cardoso
authors.forename: C A A
authors.initials: CA
authors.lastname: Caruy
authors.forename: C A F
authors.initials: CA
authors.lastname: Escanhoela
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001938:Brazil; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D047368:Tumor Burden; D055815:Young Adult