title: Revisiting the role of pathological analysis in transarterial chemoembolization-treated hepatocellular carcinoma after transplantation.
abstract: OBJECTIVE
  To define the histopathological features predictive of post-transplant hepatocellular carcinoma (HCC) recurrence after transarterial chemoembolization, applicable for recipient risk stratification.
  
  
  METHODS
  We retrospectively reviewed the specimens of all suspicious nodules (total 275) from 101 consecutive liver transplant recipients which came to our Pathology Unit over a 6-year period. All nodules were sampled and analyzed, and follow-up data were collected. We finally considered 11 histological variables for each patient: total number of nodules, number of viable nodules, size of the major nodule, size of the major viable nodule, occurrence of microscopic vascular invasion, maximum Edmondson's grade, clear cell/sarcomatous changes, and the residual neoplastic volume. Survival data were computed by means of the Kaplan-Meier procedure and analyzed by means of the Cox proportional hazards model. The multivariate linear regression and a k-means cluster analysis were also used in order to compute the standardized histological score.
  
  
  RESULTS
  The total number of nodules, the residual neoplastic volume (the total volume of all evaluated nodules minus the necrotic portion) and the microvascular invasion entered the Cox multivariate hazard model with HCC recurrence as dependent variable. The histological score was therefore computed and a cluster analysis sorted recipients into 3 risk groups, with 3.3%, 18.5% and 53.8% respectively of tumor recurrence rates and 1.6%, 11.1% and 38.5% of tumor-related mortality respectively at the end of follow-up.
  
  
  CONCLUSIONS
  The histological score allows a reliable stratification of HCC recurrence risk, especially in those recipients found out to be beyond the Milan criteria after orthotopic liver transplantation (OLT).
authors.affiliation: Francesco Vasuri, Deborah Malvi, Francesca Rosini, Pamela Baldin, Michelangelo Fiorentino, Walter Franco Grigioni, Antonia D'Errico-Grigioni, "F. Addarii" Institute of Oncology and Transplantation Pathology, S.Orsola-Malpighi Hospital, Bologna University, 40138 Bologna, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Vasuri
authors.affiliation: Francesco Vasuri, Deborah Malvi, Francesca Rosini, Pamela Baldin, Michelangelo Fiorentino, Walter Franco Grigioni, Antonia D'Errico-Grigioni, "F. Addarii" Institute of Oncology and Transplantation Pathology, S.Orsola-Malpighi Hospital, Bologna University, 40138 Bologna, Italy.
authors.forename: Deborah
authors.initials: D
authors.lastname: Malvi
authors.affiliation: Francesco Vasuri, Deborah Malvi, Francesca Rosini, Pamela Baldin, Michelangelo Fiorentino, Walter Franco Grigioni, Antonia D'Errico-Grigioni, "F. Addarii" Institute of Oncology and Transplantation Pathology, S.Orsola-Malpighi Hospital, Bologna University, 40138 Bologna, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Rosini
authors.affiliation: Francesco Vasuri, Deborah Malvi, Francesca Rosini, Pamela Baldin, Michelangelo Fiorentino, Walter Franco Grigioni, Antonia D'Errico-Grigioni, "F. Addarii" Institute of Oncology and Transplantation Pathology, S.Orsola-Malpighi Hospital, Bologna University, 40138 Bologna, Italy.
authors.forename: Pamela
authors.initials: P
authors.lastname: Baldin
authors.affiliation: Francesco Vasuri, Deborah Malvi, Francesca Rosini, Pamela Baldin, Michelangelo Fiorentino, Walter Franco Grigioni, Antonia D'Errico-Grigioni, "F. Addarii" Institute of Oncology and Transplantation Pathology, S.Orsola-Malpighi Hospital, Bologna University, 40138 Bologna, Italy.
authors.forename: Michelangelo
authors.initials: M
authors.lastname: Fiorentino
authors.affiliation: Francesco Vasuri, Deborah Malvi, Francesca Rosini, Pamela Baldin, Michelangelo Fiorentino, Walter Franco Grigioni, Antonia D'Errico-Grigioni, "F. Addarii" Institute of Oncology and Transplantation Pathology, S.Orsola-Malpighi Hospital, Bologna University, 40138 Bologna, Italy.
authors.forename: Alexandro
authors.initials: A
authors.lastname: Paccapelo
authors.affiliation: Francesco Vasuri, Deborah Malvi, Francesca Rosini, Pamela Baldin, Michelangelo Fiorentino, Walter Franco Grigioni, Antonia D'Errico-Grigioni, "F. Addarii" Institute of Oncology and Transplantation Pathology, S.Orsola-Malpighi Hospital, Bologna University, 40138 Bologna, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Ercolani
authors.affiliation: Francesco Vasuri, Deborah Malvi, Francesca Rosini, Pamela Baldin, Michelangelo Fiorentino, Walter Franco Grigioni, Antonia D'Errico-Grigioni, "F. Addarii" Institute of Oncology and Transplantation Pathology, S.Orsola-Malpighi Hospital, Bologna University, 40138 Bologna, Italy.
authors.forename: Antonio Daniele
authors.initials: AD
authors.lastname: Pinna
authors.affiliation: Francesco Vasuri, Deborah Malvi, Francesca Rosini, Pamela Baldin, Michelangelo Fiorentino, Walter Franco Grigioni, Antonia D'Errico-Grigioni, "F. Addarii" Institute of Oncology and Transplantation Pathology, S.Orsola-Malpighi Hospital, Bologna University, 40138 Bologna, Italy.
authors.forename: Rita
authors.initials: R
authors.lastname: Golfieri
authors.affiliation: Francesco Vasuri, Deborah Malvi, Francesca Rosini, Pamela Baldin, Michelangelo Fiorentino, Walter Franco Grigioni, Antonia D'Errico-Grigioni, "F. Addarii" Institute of Oncology and Transplantation Pathology, S.Orsola-Malpighi Hospital, Bologna University, 40138 Bologna, Italy.
authors.forename: Antonio Maria
authors.initials: AM
authors.lastname: Morselli-Labate
authors.affiliation: Francesco Vasuri, Deborah Malvi, Francesca Rosini, Pamela Baldin, Michelangelo Fiorentino, Walter Franco Grigioni, Antonia D'Errico-Grigioni, "F. Addarii" Institute of Oncology and Transplantation Pathology, S.Orsola-Malpighi Hospital, Bologna University, 40138 Bologna, Italy.
authors.forename: Walter Franco
authors.initials: WF
authors.lastname: Grigioni
authors.affiliation: Francesco Vasuri, Deborah Malvi, Francesca Rosini, Pamela Baldin, Michelangelo Fiorentino, Walter Franco Grigioni, Antonia D'Errico-Grigioni, "F. Addarii" Institute of Oncology and Transplantation Pathology, S.Orsola-Malpighi Hospital, Bologna University, 40138 Bologna, Italy.
authors.forename: Antonia
authors.initials: A
authors.lastname: D'Errico-Grigioni
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects / Q000401:mortality; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D016014:Linear Models; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Cancer recurrence; Chemoembolization; Hepatocellular carcinoma; Histopathology; Orthotopic liver transplantation; Transarterial chemoembolization