Liver transplantation
Outcome
Comparison of Clinical and Pathological Staging and Long-Term Results of Liver Transplantation for Hepatocellular Carcinoma in a Single Transplant Center

https://doi.org/10.1016/j.transproceed.2006.02.015Get rights and content

Abstract

Liver transplantation (OLT) is a treatment for hepatocellular carcinoma (HCC) superimposed on cirrhosis provided that the disease meets defined criteria. The aim of the study was to evaluate our experience with respect to clinical and pathological staging and long-term results. From 1996 to 2005, 50 patients underwent OLT for HCC including 43 men (86%) and seven women (14%) of median age 57 years (range 37 to 67). All patients fulfilled the Milan criteria. The HCC diagnosis was based on preoperative imaging and alpha-fetoprotein levels; no tumor biopsy was performed. Upon histological examination of the resected specimens, we discovered 6 (12%) incidentalomas and 8 (16%) cases of no HCC. Finally we had 42 “true” HCC. Twenty-six patients (52%) have been downstaged and 10 (20%) upstaged by preoperative imaging; 15% were pT1, 45% were pT2, 27% pT3, and 13% pT4a. Twenty-six percent of cases exceeded the Milan criteria. One patient (pT4a) with microvascular invasion died of pulmonary metastases at 14 months after transplantation. No HCC recurrences within the liver have been encountered at a median follow-up of 20 months (range 0 to 80 months). Overall the estimated 1-, 3-, and 5-year survival rates were 83%, 77%, and 72%, respectively. One-, 3-, and 5-year estimated survival rates were 87%, 75%, and 75% for pT1, and pT2, and 75%, 67%, and 67% for pT3 and pT4a, respectively (P = .99). Based on our experience OLT for HCC has long-term results comparable to those without HCC despite the presence of a significant number of cases exceeding the Milan criteria upon pathological staging.

Section snippets

Patients and methods

From 1996 to 2005, 50 patients underwent orthotopic liver transplantation (OLT), 48 from cadaveric and two from living donors, for HCC, accounting for 17.5% of all the primary indications for OLT performed at out center. There were 43 men (86%) and seven women (14%) of overall median age of 57 years (range 37 to 67). All patients fulfilled the Milan criteria at transplantation, since the policy of our center was to exclude HCC exceeding the Milan criteria. The diagnosis of HCC was based on

Results

Upon histological examination of the whole extirpated liver, we discovered 6 (12%) incidentalomas, while in 8 (16%) cases there was no HCC. Finally we had 42 “true” HCC based on pathological examination. Twenty-six patients (52%) were downstaged and 10 (20%) upstaged from the preoperative imaging based on pathological examination of the specimens. After transplantation 15% of patients were pT1; 45% were pT2; 27% pT3; and 13% pT4a. Thirty-one percent and 69% of patients showed monofocal and

Discussion

The appropriate selection criteria for patients with presumed or confirmed HCC depends on both the extent of disease and the degree of liver dysfunction. Preoperative staging continues to be controversial whether spiral CT or magnetic resonance imaging is the best imaging method.4 The importance of pretransplant tumor biopsy has recently been reemphasized, after a period of quiescence, in order to define the biologic behavior of the tumor.5 These criteria are currently used by UNOS for the

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