Analysis of prognostic factors of more/equal to10 years of survival for liver cancer patients after liver transplantation

Abstract

ObjectiveTo investigate prognostic factors of more than 10 years of survival for liver cancer patients after liver transplantation.MethodsFrom May 2000 to May 2007, a total of 134 liver cancer patients who underwent liver transplantation in the Department of Hepatobiliary Surgery, Peking University People’s Hospital, were continuously and retrospectively enrolled. The patients included 120 males and 14 females. There were 124 cases (92.5%) of primary hepatocellular carcinoma, 9 cases (6.7%) of cholangiocarcinoma, and 1 case of mixed hepatocellular carcinoma and cholangiocarcinoma. Patients with perioperative death were excluded. Follow-up was performed until May 31st, 2017 or the time of death. According to the data on postoperative survival time, patients were divided into a < 10 years group (81 cases) and a ≥ 10 years group (53 cases). Patients’ clinical data were recorded and analyzed, including alpha-fetoprotein (AFP) level (≥ 400 µg/L or < 400 µg/L), number of tumor lesions (< 3 or ≥ 3), tumor size (≤ 5 cm or > 5 cm), vascular tumor thrombus (large blood vessel or non-large blood vessel), and histological differentiation degree. The Kaplan–Meier method was used to calculate survival rates. The log-rank method was used to compare the differences between survival curves. The Cox proportional hazards regression model was used to perform multivariate analyses of possibly influential factors.Results(1) Follow-up was conducted with all 134 liver cancer patients after liver transplantation. The follow-up periods were 1–201 months, with a median of 18 (8.75, 132.5) months. The Kaplan–Meier survival analysis results showed that the 1-year, 3-year, 5-year, and 10-year cumulative survival rates were 70.3%, 48.6%, 46.8%, and 46.8%, respectively. (2) The differences in the age of patients, the incidence rate of AFP ≥ 400 µg/L, tumor histological differentiation, vascular tumor thrombi, tumor lesion size, and number of tumor lesions between two groups were all statistically significant (all P < 0.01). (3) The cumulative survival rates were different in AFP (log-rank χ2 = 13.428), histopathologic differentiation (log-rank χ2 = 33.592), large blood vessel tumor thrombi (log-rank χ2 = 36.470), tumor lesion size (log-rank χ2 = 39.835), and number of tumor lesions (log-rank χ2 = 47.016), and there were statistically significant differences between groups (all P < 0.01). (4) Multivariate Cox proportional hazards regression analyses showed that ≥ 3 tumor lesions [hazard ratio (HR) = 2.879, 95% confidence interval (CI) 1.566–5.422], tumor lesion size > 5 cm (HR = 2.682, 95% CI 1.382–5.366), large blood vessel tumor thrombi (HR = 1.831, 95% CI 1.010–3.341), and poor histological differentiation (HR = 2.150, 95% CI 1.372–3.394), were risk factors affecting the 10-year survival of liver cancer patients after liver transplantation (all P < 0.05).ConclusionTumor size, tumor number, large blood vessel tumor thrombi, and low tumor differentiation were all found to be independent risk factors affecting the 10-year survival rate after li...

Comparison of 10-Year Survival Outcomes for Early Single Hepatocellular Carcinoma following Different Treatments

“…Several studies have focused on the 10-year survivors of HCC, and these studies only focus on one treatment [4][5][6][7]. Liver transplantation is the optimal treatment option for early HCC, but it was limited by lack of donor organs.…”

“…Liver transplantation is the optimal treatment option for early HCC, but it was limited by lack of donor organs. One study reported that the actual 10-year survival rate for HCC patients who had liver transplantation was 41.1% [ 6 ]. For patients who underwent resection, the actual 10-year survival rate of patients was about 7.2%, whereas the actuarial survival quoted from the same studies was 26.8% [ 8 ].…”

Bridging and downstaging role of trans-arterial radio-embolization for expected small remnant volume before liver resection for hepatocellular carcinoma

“…Liver transplantation is applied for selected patients with early stage HCC with favorable tumor biology. 1 , 2 Therefore, liver resection plays an important role in the treatment of HCC patients. However, many HCC patients are not candidates for liver resection at the time of diagnosis due to poor liver functions, multifocal tumor, small remnant liver volume or proximity to major hepatic vasculatures.…”

Prognostic factors of patients after liver cancer surgery

“…The treatments for early-stage patients include hepatectomy, transplantation and radiofrequency ablation [4–7] . However, most patients are diagnosed at an advanced stage of liver cancer, thus the curative rates of the above treatments are relatively low [8] . Therapies for patients at more advanced stage contain trans-arterial chemoembolization and chemotherapy [7] .…”

“…[4][5][6][7] However, most patients are diagnosed at an advanced stage of liver cancer, thus the curative rates of the above treatments are relatively low. [8] Therapies for patients at more advanced stage contain transarterial chemoembolization and chemotherapy. [7] However, the chemoresistance of liver cancer is considerably high and this may lead to a low overall response rate.…”