Article
Liver transplantation for hepato cellular carcinoma: a single center oncological resume overlooking four decades of experience
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Published: | April 26, 2013 |
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Introduction: Liver transplantation (LT) is considered to be the best treatment for hepatocellular carcinoma (HCC). We report our oncological resume overlooking four decades of LT for HCC.
Material and methods: All consecutive LT for HCC at our institution between 1975 and 2011 were included (n=319). Predictors of survival were identified by COX regression, Kaplan-Meier survival analysis, Log Rank and Chi-square tests where appropriate.
Results: The maximum cumulative HCCR incidence of 45% was reached at 10.5 years after LT. HCCR was identified by COX regression analysis as a very strong negative predictor of survival (p<0.001, exp(B)/hazard=10.156). Survival at 5, 10 and 30 years after LT was 80%, 67% and 45% in HCCR-free patients compared to 28%, 15% and 10% for patients with HCCR. Significant hazards for HCCR were LT outside hMILAN (p<0.001, exp(B)=3.645), grading G3-4 (p<0.001, exp(B)=8.668) and vascular infiltration of small vessels (p<0.001, exp(B)=11.612) and large vessels (p<0.001, exp(B)=18.324). Underlying diseases and neo-adjuvant therapy had no significant impact on HCCR. Small and large vascular infiltrations were both associated with a significant hazard for survival (p=0.001, exp(B)=13.337; p<0.001, exp(B)=16.737; respectively). Neo-adjuvant therapy improved survival significantly when only HCCR related deaths were analyzed (p=0.024, exp(B)=0.562). Grading beyond G2 was associated with a higher hazard ratio for long-term survival (exp(B)=10.498) as compared to LT beyond hMILAN (exp(B)=4.533). Grading has a significant statistical influence on vascular infiltration (p=0.006; Chi-square). Figure 1 [Fig. 1].
Conclusion: LT can enable survival of HCC over several decades. De-differentiation of HCC leads to vascular infiltration which is a highly significant hazard for HCCR and deteriorates survival. Therefore we believe that pre-transplant staging should include grading by biopsy, because grading appears to be the most reliable pre-transplant predictor for post-transplant survival. Further de-differentiation of HCC should be prevented by bridging therapy.