title: Impact of Histological Factors of Hepatocellular Carcinoma on the Outcome of Liver Transplantation.
abstract: BACKGROUND
  The aim of this study was to identify predictors of overall survival (OS), disease-free survival (DFS), and recurrence in a cohort of 151 patients with hepatocellular carcinoma (HCC) and cirrhosis who were treated by liver transplantation (LT).
  
  
  METHODS
  A retrospective database of patients undergoing LT for radiologically diagnosed HCC at "12 de Octubre" Hospital, Madrid during 1986-2006 was analyzed.
  
  
  RESULTS
  The median follow-up was 67.44 months (SD = 55.7 months). Overall 1-, 3-, 5-, and 10-year survival was 87.5%, 73.7%, 64.1% and 43.4%, respectively. The 5-year OS of patients beyond the Milan criteria was 47.14%, whereas that of patients within the Milan criteria was 70.13% (P = .011). The 5-year OS of patients beyond the Milan criteria and with microvascular invasion (MVI) was 27.27%, whereas that of patients beyond the Milan criteria and without MVI criteria was 57.89% (P = .003). Multivariate analysis of prognostic factors revealed MVI and G3 to be independent and statistically significant factors affecting OS (P < .0001 and P = .045, respectively), DFS (P < .0001 and P = .004, respectively), and recurrence (P = .0002 and P = .028, respectively). Multivariate analysis of prognostic factors also revealed preoperative fine-needle aspiration (FNA) to be an independent negative statistically significant factor affecting recurrence (P = .0022). Multivariate analysis of predictive MVI factors revealed preoperative α-fetoprotein (AFP) levels >200 ng/mL to be an independent positive and statistically significant predictor of MVI (P = .0004).
  
  
  CONCLUSIONS
  MVI and G3 are independent negative factors affecting OS, DFS, and recurrence. The presence of MVI or AFP levels >200 ng/mL represent a contraindication for LT, as long as the patient is beyond the Milan criteria.
authors: Department of General and Visceral Surgery, Infanta Leonor Hospital, Madrid, Spain.
authors: M
authors: M
authors: Donat
authors: Department of General and Visceral Surgery, Fuenlabrada University Hospital, Madrid, Spain. Electronic address: y.dum@hotmail.com.
authors: S
authors: S
authors: Alonso
authors: Department of General and Visceral Surgery, Fuenlabrada University Hospital, Madrid, Spain.
authors: F
authors: F
authors: Pereira
authors: Department of General and Visceral Surgery, "12 de Octubre" University Hospital, Madrid, Spain.
authors: E
authors: E
authors: Ferrero
authors: Department of General and Visceral Surgery, Fuenlabrada University Hospital, Madrid, Spain.
authors: L
authors: L
authors: Carrión
authors: Department of General and Visceral Surgery, Fuenlabrada University Hospital, Madrid, Spain.
authors: D
authors: D
authors: Acin-Gándara
authors: Department of General and Visceral Surgery, "12 de Octubre" University Hospital, Madrid, Spain.
authors: E
authors: E
authors: Moreno
mesh_terms: D000328:Adult; D000368:Aged; D044963:Biopsy, Fine-Needle; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000473:pathology* / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000097:blood / Q000473:pathology* / Q000601:surgery*; D016031:Liver Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D000509:alpha-Fetoproteins / Q000032:analysis
chemical_list: D000509:alpha-Fetoproteins