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

Liver transplantation in the treatment of patients with hepatocelular carcinoma

“…The presented distant liver transplantation results in case of patients with hepatocellular carcinoma correspond to results obtained by leading European and world centers (5,10,20,21). In comparison to data obtained from the European Liver Transplantation Registry the one, three, and five-year survival rates in our study are higher.…”

“…In most cases the carcinoma develops in patients with liver cirrhosis (4,5). Risk factors of hepatocellular carcinoma development include chronic hepatitis B, C and D infections, alcoholism, diabetes mellitus, obesity, smoking, and others (6,7,8).…”

Radiofrequency‐Assisted liver resection in cirrhotic patients with hepatocellular carcinoma

“…Liver transplantation is currently the best treatment for HCC and it is considered the only curative treatment option with 5-year survival rates better than liver resection when patients are carefully selected according to Milan criteria (77% vs. 26-50%, respectively) [1,5]. However, there is a growing disparity between the demand for and the supply of organs for transplantation.…”

“…Recent data from UNOS indicate that only 335 (7.9%) of the 3,893 liver transplantation performed in the United States in 2003 were for malignant neoplasm [1,6]. A large number of liver transplantation candidates remain on the waiting list until they die from tumor progression or cirrhosis-related complications [1,5,6]. Liver-directed therapies as radiofrequency ablation (RFA), percutaneous ethanol injection (PEI) or transarterial hepatic artery chemoembolisation (TACE) showed no evidence of significant improvement in long-term survival in cirrhotic patients with HCC [1,7].…”

What is the best staging system for hepatocellular carcinoma in the setting of liver transplantation?

“…For those patients who have undergone transplantation, the postoperative staging should include pathological features, which are obviously not available before transplantation and thus cannot be used for determining a patient's suitability for transplantation or allocation. In addition, up to 30% of patients who are diagnosed with HCC by preoperative imaging or AFP levels have alternative histological diagnoses and should thus be down-staged, [54][55][56] and many small HCCs that are detected by pathological examinations are not diagnosed preoperatively (mostly small lesions with little impact on survival). 57,58 Although the decision to perform transplantation or to consider a patient within the criteria for transplantation may be based on the imaging stage, the new TNM staging system by definition includes the results of a pathological examination.…”