Survival after liver transplantation in cirrhotic patients with and without hepatocellular carcinoma: A comparative study

Abstract

lected HCC are similar to the results in cirrhotic patients Cumulative recurrence after surgical resection for hewithout tumor. (HEPATOLOGY 1997;25:1485-1489.) patocellular carcinoma (HCC) is very high. Several retrospective analyses have shown that liver transplantation was more effective than resection for patients with Hepatocellular carcinoma (HCC) usually occurs with the HCC at early tumor stages. Consequently, in January presence of cirrhosis and is considered to have a poor progno-1990, we decided to prospectively indicate orthotopic sis.1 To the present, surgical resection has been the treatment liver transplantation (OLT) as the first surgical treat-of choice whenever feasible.2 However, the resection rate rement for small, localized HCC in cirrhotic patients with-mains low in cirrhotic patients. 3,4 In the last few years, some out nodal involvement independently of the degree of groups have reported disappointing long-term results after liver function. The aim of this prospective cohort study resection of small tumors in cirrhotic patients. The 5-year was to analyze prognosis, recurrence rate, and survival recurrence rate is very high, 74% among 386 patients acafter liver transplantation in patients in whom the main cording to Makuuchi, 5 and 100% in Belghiti's series. 6 Other indication was HCC with cirrhosis. Thirty-eight patients authors have accepted orthotopic liver transplantation (OLT) in whom the main indication for liver transplantation as a treatment indication in patients with advanced tumors was HCC and hepatic cirrhosis were compared with 136 or with associated end-stage liver disease.7-11 Moreover, sevtransplantations because of cirrhosis without tumor, eral retrospective analyses have recently shown that OLT performed in our unit from January 1990 to December was more effective than liver resection for patients with HCC 1995. HCC arising in noncirrhotic livers and those inci-at early tumor stages. 7,8,10,11 However unfavorable results dently discovered after OLT were excluded from the compared with benign disease and a shortage of donor organs study. Chemoembolization using doxorubicin, lipiodol, have led to a restricted indication of liver transplantation for and Gelfoam was performed before OLT in 31 patients HCC.12-14 On the other hand, the absence of recurrence after with good liver function. There were no differences in transplantation for incidental HCC prompted us to look for gender, but HCC patients were older (57 { 7 vs. 50 { 10 favorable preoperative staging criteria for small HCC in ciryears [P õ .001]). Liver function was better in HCC rhosis with regard to OLT, 15 but there is no general agree-(Child-Pugh score: 6.9 { 2 vs. 8.6 { 1.8; P õ .001), and ment as to the selection of ideal candidates for OLT. [7][8][9][10][11][12]16 hepatitis C virus antibody was positive in 31 (82%) vs. 51The 5-year survival rate after liver resection for HCC is (37%) (P õ .007). Seven tumors had bilobar involvement very poor, ranging from 12% to 50% in both eastern and (18%). Capsule was presen...

Which matters most: Number of tumors, size of the largest tumor, or total tumor volume?

“…13,27,31,44,[60][61][62][63][64][65][66][67][68][69][70][71][72][73][74] Four studies treated the tumor size as a continuous variable, and they all assessed overall survival (HR ¼ 1.14, 95% CI ¼ 1-1.30; Table 1). 67,69,71,74 Sixteen studies treated the tumor size as a cutoff.…”

“…,27,31,44,[60][61][62][63][64][65][66][67][68]70,72,73 The HR for overall survival was reduced by 1.92 (95% CI ¼ 1.48-2.50) in patients with a tumor size ! 5 cm versus patients with a tumor size < 5 cm.…”

High Hepatitis B Virus DNA Level in Serum before Liver Transplantation Increases the Risk of Hepatocellular Carcinoma Recurrence

“…However, survival after transplantation for HCC was disappointing before the introduction of Milan criteria for selecting candidates for OLT [2]. With application of this policy, the overall survival has now improved, but is slightly lower than that of patients without HCC who undergo OLT [3]. Multiple studies have focused on the risk factors related to developing tumor recurrence after OLT, including tumor morphology, differentiation grade and preoperative serum a-fetoprotein (AFP) level, etc.…”

Tumor diagnosis in the adult liver transplant candidate

“…On the other hand, recurrence and mortality after liver transplantation in cirrhotic patients with carefully selected HCC are similar to the results in cirrhotic patients without tumor [37]. Imaging is required to give accurate staging in the preoperative period.…”