Indicators of prognosis after liver transplantation in Chinese hepatocellular carcinoma patients

Abstract

AIM:To identify prognostic factors of patients with hepatocellular carcinoma (HCC), who were treated by orthotopic liver transplantation (OLT). METHODS:From January 2000 to October 2006, 165 patients with HCC underwent OLT. Various clinicopathological risk factors for actuarial and recurrencefree survival were identified using the Kaplan-Meier method with the log-rank test. The Cox proportional hazards model was used to identify independently predictive factors for actuarial and recurrence-free survival, which were used to propose new selection criteria. We compared the outcome of the subgroup patients meeting different criteria. Survival analysis was performed using the Kaplan-Meier method with the log-rank test. RESULTS:The median follow-up was 13.0 mo (2.8-69.5 mo). Overall, 1-, 2-, 3-and 5-year actuarial survival was 73.3%, 45.6%, 35.4% and 32.1%, respectively. One-, 2-, 3-and 5-year overall recurrencefree survival was 67.0%, 44.3%, 34.5% and 34.5%, respectively. In univariate analysis, number of tumors, total tumor size, lobar distribution, differentiation, macrovascular invasion, microvascular invasion, capsulation of the tumor, and lymph node metastasis were found to be associated significantly with actuarial and tumor-free survival. By means of using the multivariate Cox proportional hazards model, total tumor size and macrovascular invasion were found to be independent predictors of actuarial and tumor-free survival. When the selection criteria were expanded into the proposed criteria, there was no significant difference in 1-, 2-, 3-and 5-year actuarial and tumor-free survival of the 49 patients who met the proposed criteria (97.6%, 82.8%, 82.8% and 82.8%, and 90.7%, 82.8%, 68.8% and 68.8%, respectively) compared with that of patients who met the Milan or University of California, San Francisco (UCSF) criteria. CONCLUSION:Macrovascular invasion and total tumor diameter are the strongest prognostic factors. The proposed criteria do not adversely affect the outcome of liver transplantation for HCC, compared with the Milan or UCSF criteria.

General evaluation of hepatectomy and hepatocellular carcinoma cases

“…Our country falls between these two groups (3-6, 11). More than 80% of HCC cases develop on the basis of cirrhotic chronic liver disease globally (3)(4)(5)(6)10,(16)(17)(18). The presence of cirrhosis in the etiology of HCC has been reported as 74% and 87% in Turkey (3,5).…”

“…The presence of cirrhosis in the etiology of HCC has been reported as 74% and 87% in Turkey (3,5). This ratio varies between 62-75% in transplantation series (7)(8)(9)(10)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22). It is 98.8% in our series.…”

“…The frequency of HCC is significantly higher in the Asia and Africa continents and the incidence is increasing (1,2,7,10). HBV is endemic in our country and the HBV carrier rate is 5-10%.…”

“…The most important cause is hepatitis B and hepatitis C infections. The other major causes are alcohol, aflatoxin exposure, hereditary hemochromatosis, primary sclerosing cholangitis, autoimmune hepatitis, and cryptogenic hepatitis (3)(4)(5)(7)(8)(9)(10).…”

Living vs. deceased-donor liver transplantation for patients with hepatocellular carcinoma

“…In this study, they compared the results of 66 LDLTs and 163 DDLTs, after excluding 26 patients who died during the perioperative period, in terms of their compliance with the Milan criteria, UCSF criteria, up-to-seven criteria (32), Hangzhou criteria (33), and Chengdu criteria (34). The overall recurrence-free survival and OS rates of the Milan criteriabased recipients, UCSF recipients, up-to-seven recipients, Hangzhou recipients, and Chengdu recipients after LDLT and DDLT were all similar.…”