What Factors Predict Survival in Patients with Hepatocellular
Carcinoma and Cirrhosis Who Receive Liver Transplants?
The aim of this study was to identify predictors
of both survival and tumor-free survival of a cohort of 155
patients, with hepatocellular carcinoma (HCC) and cirrhosis, who were treated by orthotopic liver transplantation (OLT).
From January 1989 to December 2002, 603 OLTs were performed in 549 patients. HCC was diagnosed in
116 patients before OLT and in 39 at histological examination
of the explanted livers.
Eighty-four percent of the patients met “Milan” criteria at histology.
Ninety-four patients received anticancer therapies preoperatively.
Results
The median follow-up was 49 months (range, 0–178).
Overall,
1-, 3-, 5-, and 10-yr survival were 84%, 75%, 72%, and 62%,
respectively.
Survival
was not affected by the patient's age or sex, etiology of
liver disease, Child score at transplantation, rejection
episodes, tumor number, total tumor burden, bilobar
tumor, and pathologic Tumor, Nodes, Metastasis (pTNM)
stages. T
There
was no statistically significant difference in survival
when patients were grouped according to the recently proposed
simplified pTNM staging (5-yr
survival, 80% in stage I, 69% in stage II, 50% in stage
III, p= 0.3) or the United Network for Organ Sharing
(UNOS) staging system for HCC.
Encapsulation of the tumor and α-fetoprotein levels significantly
affect
patient survival.
Five-year
survival of patients with poorly differentiated (G3) HCC
was significantly worse than that of patients with moderately
(G2) or well-differentiated (G1) HCC (respectively, G3 44%,
G2 67%, and G1 97%, p= 0.0015).
Patients
with micro- or macro-vascular invasion had a worse 5-yr
survival than patients without vascular invasion (49%vs
77%, p= 0.04).
Multivariate
analysis showed that histological grade of differentiation
and macroscopic vascular invasion are independent predictors
of survival (p= 0.022).
In conclusion, the authors write, “Histological
grade of differentiation and macroscopic vascular invasion,
as assessed on the explanted livers, are strong predictors
of both survival and tumor recurrence in patients with cirrhosis
who received transplants for HCC.”
10/17/05
Reference
C
Zavaglia and others. American Journal of Gastroenterology
100(10): October 2005.
