title: Long-term outcomes of patients with primary biliary cirrhosis and hepatocellular carcinoma.
abstract: OBJECTIVE
  Hepatocellular carcinoma (HCC) is an aggressive tumor that frequently develops in patients with primary biliary cirrhosis (PBC). We determined the mortality of patients with PBC who develop HCC, and which interventions (surgery, radiofrequency ablation, chemoembolization, alcohol injection, or transplantation) increase survival times. We investigated whether the Milan criteria predict outcomes of these patients and are effective in selection for liver transplantation.
  
  
  METHODS
  We evaluated data from 38 patients who had a confirmed diagnosis of PBC and HCC between March 1993 and February 2011. Patients were grouped based on whether or not they met the Milan criteria. Survival was assessed using the Kaplan-Meier analysis.
  
  
  RESULTS
  Eighteen of the 38 patients (47.3%) died during the follow-up period; 49.4% survived for 5 years and 31.7% survived for 10 years. Thirty-five patients (92.0%) underwent one or a combination of interventions. Liver transplantation improved survival (risk ratio, 0.06; P < .0001), whereas surgery approached significance in causing deterioration (risk ratio, 2.87; P = .07). Mortality did not appear to be affected by meeting the Milan criteria (P = .84).
  
  
  CONCLUSIONS
  Five- and 10-year survival times for patients with PBC who developed HCC were 49.4% and 31.7%, respectively. Patients who meet the Milan criteria receive liver transplantation as often as those who do not; we did not observe a difference in survival time between groups. Patients with PBC who develop HCC appear to benefit from aggressive therapies.
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota 55905, USA.
authors.forename: Mohamad H
authors.initials: MH
authors.lastname: Imam
authors.forename: Marina G
authors.initials: MG
authors.lastname: Silveira
authors.forename: Emmanouil
authors.initials: E
authors.lastname: Sinakos
authors.forename: Andrea A
authors.initials: AA
authors.lastname: Gossard
authors.forename: Roberta
authors.initials: R
authors.lastname: Jorgensen
authors.forename: Jill
authors.initials: J
authors.lastname: Keach
authors.forename: Alisha C
authors.initials: AC
authors.lastname: DeCook
authors.forename: Keith D
authors.initials: KD
authors.lastname: Lindor
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008105:Liver Cirrhosis, Biliary / Q000150:complications* / Q000401:mortality / Q000628:therapy*; D016031:Liver Transplantation; D008297:Male; D016019:Survival Analysis; D016896:Treatment Outcome