Prognosis of Hepatocellular Carcinoma after Liver Transplantation: Comparative Analysis with Partial Hepatectomy

Abstract

BackgroundLiver transplantation (LT) is the treatment of choice for hepatocellular carcinoma (HCC). The aim of this study was to investigate the recurrence rate of HCC after LT and prognostic factors for recurrence by comparing LT with non-transplanted resection. MethodsThe participants were 338 patients who underwent LT between 1996 and 2012 at Seoul National University Hospital (LT group) and 520 HCC patients who underwent partial hepatectomy between 1995 and 2006 (control group, non-LT group). ResultsIn the LT group, 68 of 338 patients (19.8%) showed relapse, and the recurrence rate was lower than that in the non-LT group (64.9%, 357/520, p < .001). Stratification analysis by American Joint Committee on Cancer (AJCC) stage showed that the stage I-II LT group had a lower recurrence rate than the non-LT group. Univariate comparative analysis demonstrated that multiplicity of tumor, tumor size, gross type, Edmondson- Steiner (ES) nuclear grade, extent of tumor, angioinvasion, AJCC stage, Milan criteria, University of California at San Francisco criteria on explant pathology (all p < .001), positive expression of cytokeratin 19 (p = .002), and preoperative α-fetoprotein (AFP) (p < .001) were predictors of tumor recurrence. In multivariate analysis, LT, preoperative AFP, multiplicity of tumor, extent of tumor, size of tumor, and ES nuclear grade were independent prognostic factors. ConclusionsLT might have a protective effect against the late recurrence of stage I-II HCC compared to non-LT, and the prognostic factors for recurrence were similar to previously well-known prognostic factors for HCC.

Novel Clinical prognostic model to predict survival in hepatocellular carcinoma after LR or LT should be considered including biological characteristics and inflammation score

“…In Lee's report (22), the overall recurrence rates for 388 patients with LT and 520 patients with LR were 0.198 and 0.649, respectively. Statistical level of α = 0.001 and β = 0.01 were used to compare the sample rates for each group, which required at least 62 patients for each group.…”

Ten-year survival and recurrence of hepatocellular cancer

“…Zheng et al [22] in 212 patients who underwent liver resection showed that 77% of the short term survivors developed recurrence within 2 years while 42% of the 10 year survivors developed recurrence most of whom had intrahepatic recurrences that were treatable. In a study of 878 patients with HCC, Lee et al [25] reported a 19.8% recurrence after transplant compared to a 64.9% recurrence after resection and suggested that transplant may have a protective effect against late recurrence of early stage HCC. Risk factors for recurrence included multiple tumors, tumor size, histologic features (grade, extent, vascular invasion) and preoperative AFP.…”