Liver transplantation for unresectable hepatocellular carcinoma in normal livers

Mergental, Hynek; Adam, René; Ericzon, Bo Göran; Kaliciński, Piotr; Mühlbacher, F.; Höckerstedt, Krister; Klempnauer, Jürgen; Friman, Styrbjörn; Broelsch, Christoph E.; Mantion, Georges; Fernandez-Sellez, Carlos; Hoek, Bart van; Fangmann, J.; Pirenne, Jacques; Muiesan, Paolo; Königsrainer, Alfred; Mirza, Darius F.; Lerut, Jan; Detry, Olivier; Treut, Y. P. Le; Mazzaferro, Vincenzo; Löhe, F.; Berenguer, Marina; Clavien, Pierre Alain; Rogiers, Xavier; Belghiti, Jacques; Kóbori, L; Burra, Patrizia; Wolf, Philippe; Schareck, W.; Pisarski, Przemyslaw; Foss, Aksel; Filipponi, Franco; Krawczyk, Marek; Wolff, Martin; Langrehr, Jan M.; Rolles, K; Jamieson, Neville V.; Hop, Wim C. J.; Porte, Robert J.

doi:10.1016/j.jhep.2012.03.022

Cited by 54 publications

(54 citation statements)

References 41 publications

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“…The results of the ELTR study (unpublished data, 2011) confirm these findings. These observations, along with the fact that (1) FL-HCC did not differ from other HCCs arising in a normal liver with respect to any variable (except for the tumor size and the Milan inclusion criteria) 39 and (2) the proliferative activities of these tumor variants (eg, as determined by immunohistochemistry for Ki-67) were also similar, 35,43,44 explain why HCC in normal livers and FL-HCC were deliberately pooled together in the ELTR study. This allowed a valuable statistical evaluation of the place of LT in the treatment of NC-HCC to be made.…”

Section: Resultsmentioning

confidence: 56%

“…LT [37][38][39][40][41][42] (Table 2) In 1999, Houben and McCall 33 published the reported experience with LT for HCC in patients without an underlying disease . One hundred twentysix LT procedures were reported in 16 articles.…”

Section: Resultsmentioning

confidence: 99%

“…Lymph node invasion and vascular invasion are the main predictors of recurrence and DFS after LT. An in-depth analysis of 27 well-documented NC-HCC patients who underwent LT (including 21 FL-HCC patients) and 62 ELTR patients who underwent primary LT for unresectable NC-HCC (including 7 FL-HCC patients) supports this. 38,39 In the ELTR study, the actuarial 5-year OS and DFS rates were 49% and 49%, respectively. The median tumor diameter in this patient group was 11 cm; only 5% of the patients fulfilled the Milan criteria.…”

Section: Resultsmentioning

confidence: 99%

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Place of liver transplantation in the treatment of hepatocellular carcinoma in the normal liver

et al. 2011

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Hepatocellular carcinoma (HCC) is a relatively common cancer and occurs mainly in patients with liver cirrhosis (85%-95%). A significant number of cases are, however, diagnosed in normal and noncirrhotic/nonfibrotic livers. In contrast to HCC in a cirrhotic liver, noncirrhotic hepatocellular carcinoma (NC-HCC) predominantly occurs in young and healthy female patients in their 30s, and the diagnosis is frequently made at an advanced stage in the absence of a clear etiological factor. [1][2][3] The same holds true for the uncommon fibrolamellar hepatocellular carcinoma (FL-HCC) variant. [1][2][3] Several studies have shown that the 3-year overall survival (OS) rates with different pharmaceutical, radiological, and surgical therapies for HCC (if they are adequately performed) are approximately 60%. 4 After 3 years, the results of these treatments start to diverge substantially with respect to OS and, most importantly, with respect to disease-free survival (DFS). Long-term follow-up (5-10 years) has clearly shown that surgical resection is the only curative treatment for any kind of HCC. [2][3][4][5] With respect to very long-term DFS (>5 years), liver transplantation (LT) offers the best results. 2,4-6 In order to be successful, surgery has to be adapted to the tumor, the underlying condition of the patient, and the patient's liver. Liver resection and LT should have complementary roles rather than competing ones, and they should be associated with each other instead of being opposed. 5 Partial resection for HCC can be considered only for patients with well-compensated cirrhosis or fibrosis or with normal liver tissue. For patients with decompensated liver disease, cirrhosis, or a technically unresectable tumor, LT offers the best chance for a cure. This option indeed addresses the tumor as well as the underlying liver disease.Despite the extensive experience with LT for the treatment of HCC in patients with cirrhosis, the experience with LT for the treatment of NC-HCC is anecdotal and is limited to situations in which resection is not possible.The aims of this study were as follows: (1) to analyze the results from recent series of partial liver resections for NC-HCC, (2) to compare these results with the results of LT for the same condition; and (3) to propose an adaptation of the therapeutic algorithm for NC-HCC on the basis of these analyses.

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Section: Resultsmentioning

confidence: 56%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Place of liver transplantation in the treatment of hepatocellular carcinoma in the normal liver

et al. 2011

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“…Increasing experience has led to the conclusion that LT for NCHCC can yield 5-year DFS and OS of 49% [80,81]. Criteria used to select cirrhotic patients for LT cannot be directly applied to NCHCC because most of these lesions are large at time of detection.…”

Section: Should Lt Be Performed For Hcc In the Noncirrhotic Liver?mentioning

confidence: 99%

“…Criteria used to select cirrhotic patients for LT cannot be directly applied to NCHCC because most of these lesions are large at time of detection. The European Liver Transplant Registry data suggest that macrovascular invasion and node positivity are important determinants of poor survival after LT [81].…”

Section: Should Lt Be Performed For Hcc In the Noncirrhotic Liver?mentioning

confidence: 99%

Liver Transplantation for HCC: A Review

Kakodkar¹,

Soin²

2011

Indian J Surg

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Hepatocellular carcinoma (HCC) often occurs in patients with chronic liver disease or cirrhosis. Liver transplantation for hepatocellular carcinoma has the potential to eliminate both the tumor as well as the underlying cirrhosis and is the ideal treatment for HCC in cirrhotic liver as well as massive HCC in noncirrhotic liver. Limitations in organ availability, necessitate stringent selection of patients who would likely to derive most benefit. Selection criteria have considered tumor size, number, volume as well as biological features. The Milan criteria set the benchmark for tumors that would benefit from liver transplantation but were found to be excessively restrictive. Modest expansion in criteria has also been shown to be associated with equivalent survival. Microvascular invasion is the single most important adverse prognostic factor for survival. Living donor liver transplantation has expanded donor options and has the advantage of lower waiting period and not impacting the non-HCC waiting list. Acceptable outcomes have been obtained with living donor liver transplantation for larger and more numerous tumors in the absence of microvascular invasion. Downstaging of tumors to prevent progression while waiting for an organ or for reduction in size to allow enrolment for transplantation has met with variable success.

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Survival following liver transplantation for liver-only colorectal metastases compared with hepatocellular carcinoma

Dueland

Foss

Solheim

et al. 2018

British Journal of Surgery

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Liver transplantation for unresectable hepatocellular carcinoma in normal livers

Cited by 54 publications

References 41 publications

Place of liver transplantation in the treatment of hepatocellular carcinoma in the normal liver

Place of liver transplantation in the treatment of hepatocellular carcinoma in the normal liver

Liver Transplantation for HCC: A Review

Survival following liver transplantation for liver-only colorectal metastases compared with hepatocellular carcinoma

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