影响原发性肝癌肝移植治疗的预后因素分析

目的分析影响肝癌肝移植术后生存率和无瘤生存率的危险因素，探讨国内肝移植治疗肝癌的选择标准。方法对67例接受同种异位原位肝移植治疗的原发性肝癌病人的基本资料和肿瘤相关资料包括术前病情分级、血清AFP水平、术前辅助治疗以及肝癌大小、数目、pTNM分期、肿瘤恶性程度分级等因素进行单因素和多因素分析。结果术后1年、2年累积生存率为77％、67％，6个月和12个月无瘤生存率为66％和58％。单因素分析显示对肝癌肝移植术后累积生存率影响有统计学意义的因素为CHILD分级（MELD积分）和肝外大血管侵犯；多因素分析影响肝癌肝移植术后无瘤生存率有统计学义的因素是肿瘤大小、大血管侵犯和肿瘤分化程度。结论影响肝癌肝移植术后生存率的因素仍是术前患者肝功能状态。对存在大血管侵犯的肝癌患者需严格控制肝移植术适应证，而无血管侵犯的患者在选择肝移植治疗时肿瘤大小指标可较米兰标准适当放宽。     

肝癌肝移植生存情况及预后影响因素分析（附109例报告）

目的了解原发性肝细胞癌（肝癌）患者肝移植术后的生存情况,探讨影响其预后的危险因素。方法回顾性分析2004年1月至2007年12月中山大学附属第三医院肝移植中心的109例肝癌肝移植病例的临床资料。应用Kaplan-Meier法计算累积生存率和无瘤生存率,采用Log-rank检验和Cox回归模型分别进行无瘤生存率单因素、多因素分析。结果 109例肝癌肝移植患者中,37例肿瘤复发,占总数的33.9%,复发时间2～25（中位时间8）个月。全部病例1年、3年、5年累积生存率分别为86.9%、66.1%、56.6%,而1年、3年、5年无瘤生存率分别为78.3%、64.7%、53.1%。单因素分析显示,影响肝癌肝移植术后无瘤生存率的危险因素有肿瘤大小、肿瘤侵犯血管及病理分化程度。Cox风险回归模型多因素分析发现,肿瘤侵犯血管及病理分化程度是影响肝癌肝移植患者术后无瘤生存率的独立危险因素（均为P〈0.05）。结论影响肝癌肝移植患者术后无瘤生存率的独立危险因素是术前肿瘤侵犯血管和术后病理肿瘤分化程度,应严格筛选肝癌肝移植的适应证可有效降低术后肿瘤的复发率。     

肝癌白细胞抗原-G的表达及其在肝癌肝移植预后中的价值

目的探讨人类白细胞抗原-G(human leukocyte antigen-G,HLA-G)在肝细胞肝癌组织中的表达及其在肝癌肝移植患者预后中的价值。方法回顾性分析2004年1月至2008年5月期间中山大学附属第三医院肝移植中心收治的83例肝癌肝移植患者的临床资料。应用免疫组化方法检测肝细胞肝癌组织及其癌旁组织中HLA-G的表达情况,应用Kaplan-Meier法计算累积生存率和无瘤生存率,采用log-rank检验和Cox回归模型分别进行无瘤生存率单因素和多因素分析。结果 83例肝癌肝移植患者中,35例(42.2%)肿瘤复发。全部病例1、3和5年累积生存率分别为97.2%、89.8%和43.1%,1、3和5年无瘤生存率分别为93.6%、68.9%和38.7%。肝癌组织中HLA-G表达阳性率(68.7%)明显高于癌旁组织(15.7%,P<0.01)。HLA-G的表达与肿瘤直径、病理分级和血管侵犯有关(P<0.05)。单因素分析显示,影响肝癌肝移植术后无瘤生存率的危险因素有HLA-G表达(P<0.01)、肿瘤直径(P<0.05)、肿瘤侵犯血管(P<0.01)及病理分化程度(P<0.01)。HLA-G表达阳性组移植后的无瘤生存率低于HLA-G表达阴性组(P<0.01)。Cox风险回归模型结果表明,HLA-G表达(P<0.05)、肿瘤侵犯血管(P<0.01)及病理分化程度(P<0.05)是影响肝癌肝移植患者术后无瘤生存率的独立危险因素。结论肝癌组织存在HLA-G表达。HLA-G表达、肿瘤侵犯血管及病理分化程度是影响肝癌肝移植患者术后无瘤生存率的独立危险因素。对HLA-G表达阳性患者采取干预治疗及严格筛选肝癌肝移植的适应证可有效降低术后肿瘤的复发率。     

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目的　明确影响肝癌肝移植术后长期生存率的危险因素 ,探讨符合中国特点的肝癌肝移植适应证。方法　对 1993～ 2 0 0 3年 59例接受单纯肝移植治疗的原发性肝癌病人的移植术前基本资料和肝癌大小、数目、分布以及血管侵犯等属性采用单因素方法进行回顾性分析。结果　对肝癌肝移植术后长期生存有统计学意义的因素包括 :肝功能Child -Pugh分级、AFP水平、肿瘤大小、肿瘤数、门静脉分支侵犯等 (P <0 0 5)以及上腹部手术史 (P <0 0 1)。对肝癌肝移植术后无瘤生存有影响的因素包括上腹部手术史、肿瘤数 (P <0 0 5) ,肿瘤大小和门脉分支侵犯等 (P <0 0 1)。结论　肝功能Child -PughC分级、上腹部手术史和肿瘤侵犯门静脉分支是降低肝癌肝移植术后长期生存率的危险因素 ;而上腹部手术史、肿瘤 >5cm ,数量 >3个和门脉分支侵犯是缩短肝移植术后无瘤生存时间的危险因素。合并肝硬化 ,肿瘤直径≤ 5cm ,数目≤ 3个 ,无侵犯门静脉分支是肝癌肝移植的最佳适应证 ;门静脉分支侵犯应视为肝移植的禁忌证     

超出Milan标准肝癌肝移植患者术后预防性化疗的价值

目的 探讨超出Milan标准肝癌肝移植患者术后预防性化疗的价值.方法 回顾性分析2001年4月至2007年7月243例超出Milan标准肝癌肌移植患者的临床资料,其中预防性化疗162例,未化疗81例.结果 预防性化疗与未化疗患者术后1、3年生存率(78.5%、63.7%和56.6%、39.1%)以及无瘤生存率(76.8%、52.5%和69.3%、64.7%)比较差异无统计学意义(X2=3.084,0.444,P>0.05).Cox风险比例分析显示,对无大血管侵犯的肝癌肝移植患者,术后足否化疗不是影响生存率的独立因素;对有大血管侵犯的肝癌肝移植患者,术后是否化疗是影响生存率的独立因素.结论 对于超出Milan标准且伴有大血管侵犯的肝癌肝移植患者,术后早期预防性化疗可以延缓肿瘤复发,明显提高疗效.     

影响肝细胞癌肝移植受者预后的相关因素

目的总结原发性肝细胞癌（HCC）肝移植的临床经验，分析影响HCC肝移植受者预后的相关因素。方法回顾性分析75例HCC肝移植受者的临床资料，运用单因素及Cox回归多因素的分析方法，对10项临床和病理指标数据进行比较，筛选出影响HCC肝移植受者预后的危险因素。结果75例受者术后半年、1年及2年的累积存活率分别为：85．33％、65．70％和45．44％；无瘤存活率分别为：76．00％、55．72％和40．92％。单因素分析显示：大血管侵犯、组织分化、术前甲胎蛋白（AFP）水平、肿瘤大小、肿瘤数量及肿瘤分布是影响受者累积存活率和无瘤存活率的主要危险因素（P〈0．01）；多因素分析显示：组织分化、大血管侵犯和术前AFP水平是影响受者累积存活率和无瘤存活率的独立危险因素（P〈0．01）。结论肝移植是治疗HCC的有效方法；组织分化、大血管侵犯和术前AFP水平是影响受者预后的独立因素，而肿瘤的组织学分级对受者预后也非常重要。     

肝癌肝移植疗效评价及预后多因素分析

目的 评价肝移植治疗原发性肝癌的疗效,并分析影响预后的因素。方法 回顾性分析2001年12月至2006年12月第二军医大学附属长征医院肝移植科234例肝癌肝移植病人的临床资料。用SPSS11.0软件进行统计分析,用Kaplan-Meier法计算累计和无瘤存活率,Log-rank检验和Cox回归模型分别进行预后单、多因素分析。结果 全组随访1～56个月,随访期间死亡85例(36.3%),复发70例 (29.9%)。术后6个月及1、2、3、4年累计存活率分别为88.5%及76.3%、61.3%、53.6%、47.6%;6个月及1、2、3年无瘤存活率分别为80.1%及70.6%、60.4%、52.3%。单因素分析显示：术前肝功能Child-Pugh分级、术前甲胎蛋白（AFP）水平、肿瘤类型、肿瘤大小、淋巴结转移、大血管侵犯、肿瘤分化程度和TNM分期与预后有关;Cox回归多因素分析显示：术前AFP水平、肿瘤类型、大血管侵犯和肿瘤分化程度是影响预后的独立因素。结论 肝移植是治疗原发性肝癌的有效方法,经严格筛选的适宜受体预后良好。     

肝细胞癌肝移植术后复发和转移的研究:单中心经验

目的 研究肝细胞癌肝移植术后复发和转移的临床特点及治疗方法.方法 回顾分析2003年1月至2005年11月收治的95例肝细胞癌肝移植术后肝癌复发转移病例的临床资料.结果 在随访期内,42例(43.2%)患者被诊断为肝癌复发.复发部位最多见于移植肝(32例)、肺(21例)、骨(7例).单因素分析结果显示,肿瘤大小、肿瘤分布、肝硬化背景、术前甲胎蛋白浓度、组织学分期、大血管侵犯6项因素对肝移植术后生存和(或)肝癌复发有明显影响.多因素分析结果显示,肿瘤分布、组织学分期、大血管侵犯是影响术后总体生存率和肝癌复发率的独立危险因素.肝癌复发后的介入治疗及内放疗可延缓肿瘤进展,选择合适病例行复发灶手术切除可最大限度地改善预后.结论 合理选择接受肝移植的肝癌患者可能可以大幅度降低移植术后肝癌的复发率.在现阶段,外科治疗应是目前移植术后复发性肝癌的首选治疗手段.     

影响肝移植治疗肝细胞癌预后的相关因素分析

目的 探讨影响肝移植治疗肝细胞癌(HCC)预后的相关因素.方法 回顾性分析2004年8月至2011年2月间147例HCC患者接受肝移植治疗的临床资料.单因素分析共纳入14个指标:受者性别、年龄、血型、术前肝功能分级、终末期肝病模型评分、甲胎蛋白(AFP)水平、肿瘤数目、肝脏被肿瘤取代率、是否侵犯左右叶、累计肿瘤直径、是否侵犯肝包膜、大血管受侵犯、微血管受侵犯(MVI)以及HCC组织学分级.将差异有统计学意义的指标纳入Cox风险比例模型行多因素分析,筛选出独立危险因素.结果 143例受者获得完整随访,随访时间6～84个月,术后1、3年总体存活率分别为75.2％和54.7％,无瘤存活率分别为70％和59％.单因素分析显示,受者年龄、AFP水平、肿瘤数目、累计肿瘤直径、肝脏被肿瘤取代率、侵犯左右叶、侵犯肝包膜、大血管受侵犯、MVI等指标的差异有统计学意义(P＜0.05);经多因素分析,MVI、大血管受侵犯和AFP≥400μg/L是影响HCC患者肝移植术后存活率的独立危险因素.结论 MVI、大血管受侵犯、AFP是影响HCC肝移植术后存活率的主要危险因素,肝移植术前对其进行适当干预,术中严格按照无瘤技术操作,可明显改善预后.     

纤维板层型肝癌的治疗及预后分析

目的 总结分析纤维板层型肝癌的治疗及临床预后特点.方法 回顾分析1991年6月至2005年12月间共26例纤维板层型肝癌患者的临床病例资料.结果 全部病例获得随访,随访截至2006年10月,术后3年、5年生存率为43%、32%;术后3年、5年无瘤生存率为26%,19%,全组患者中位生存时间35.6个月.Kaplan-Meier生存分析显示:肿瘤大血管浸润、淋巴结转移、伴有肝硬化、肿瘤多发和术前肝功能状态是影响患者生存时间的危险因素;肿瘤大血管浸润、淋巴结转移、术前肝功能状态和肿瘤多发是影响患者无瘤生存时间的危险因素.结论 术前肝功能较差、伴有肝硬化、肿瘤多发、有大血管侵犯和(或)淋巴结转移的纤维板层型肝癌患者预后较差;肿瘤大血管浸润、淋巴结转移、术前肝功能较差和肿瘤多发是纤维板层型肝癌术后转移复发的危险因素.     

The Impact of Pre-Operative Loco-Regional Therapy on Outcome After Liver Transplantation for Hepatocellular Carcinoma

No prior studies have shown that pre-operative loco-regional therapy for hepatocellular carcinoma (HCC) improves survival following orthotopic liver transplantation (OLT). We performed subgroup analyses according to pathologic HCC stage among 168 patients who underwent OLT to test the hypothesis that pre-operative loco-regional therapy confers a survival advantage in a subgroup at intermediate risk for HCC recurrence. Patients with pathologic T3 HCC meeting the proposed UCSF expanded criteria (single lesion not exceeding 6.5 cm or two to three lesions none > 4.5 cm with total tumor diameter within 8 cm) had a similar 5-year recurrence-free survival as patients with pathologic T2 HCC (88.5% vs. 93.8%; p = 0.56). In the subgroup with pathologic T2 or T3 HCC, the 5-year recurrence-free survival was 93.8% for the 85 patients who received pre-operative loco-regional therapy, versus 80.6% for the other 41 patients without treatment (p = 0.049). The treatment benefit, according to 5-year recurrence-free survival, appeared greater for pathologic T3 (85.9% vs. 51.4%; p = 0.05) than T2 HCC (96.4% versus 87.1%; p = 0.12). In conclusion, although the lack of a randomized controlled design precludes drawing firm conclusions, our results suggest that pre-operative loco-regional therapy may confer a survival benefit after OLT in the subgroup with pathologic T2 and T3 HCC.     

Predictors of long-term outcome following liver transplantation for hepatocellular carcinoma: a single-center experience

Orthotopic liver transplantation (OLT) is increasingly being applied for cure in patients with cirrhosis and concomitant hepatocellular carcinoma (HCC). In recipients with limited tumor burden, OLT achieves reasonable long-term outcome. This study sought to identify clinical and pathologic variables predictive of long-term disease-free survival and the presence of vascular invasion. From 1992 to 2006, 130 patients underwent OLT for cirrhosis and HCC. Malignancy was diagnosed in 107 patients prior to OLT and in 23 patients on pathologic examination of the explant. Nine clinical and pathologic variables were considered including: TNM stage, nodularity, vascular invasion, Milan criteria, incidental lesion, differentiation, tumor size, preOLT transarterial chemoembolization (TACE), and administration of sirolimus-based immunosuppression. The overall incidence of HCC recurrence was 17% with the majority (82%) being stage III. Cumulatively, tumor recurrence-free survival (RFS) is 84, 74, and 67% at 1, 3, and 5 years respectively. Independent predictors of RFS included stage III and poorly differentiated lesions (P<0.05). Furthermore, stage III tumors and those >3.5 cm in size were predictive of vascular invasion. Importantly, preOLT, TACE and postOLT sirolimus had no influence on survival. Pathologic variables including tumor stage and grade have a significant impact on outcome. Importantly, it seems that TACE and sirolimus had no beneficial effect.     

Microvascular tumor embolism: independent prognostic factor after liver transplantation in hepatocellular carcinoma

Microscopic tumor cell dissemination may be a more important factor in the recurrence of hepatocellular carcinoma (HCC) after liver transplantation, probably because of posttransplant immunosuppression. The presence of microvascular tumor embolism was undetermined as a factor for HCC recurrence after orthotopic liver transplantation (OLT). This study evaluated whether microvascular tumor embolism affects recurrence-free survival and correlates with other clinicopathologic factors after OLT among patients with HCC. From September 1996 to June 2003, 72 OLTs for HCC were enrolled in this study. Median follow-up was 22.8 months. Among 41 patients without microvascular tumor embolism, 1-year, 2-year, and 5-year recurrence-free survival rates were all 97.6%, while these rates were 77.3%, 68.2%, and 59.7%, respectively, for 31 patients (43.1%) with microvascular tumor embolism (P = .0006). The 5-year recurrence-free survival rate showed significant differences for a pT2 tumor (P = .0073), for maximal tumor size <3 cm (P = .0328), for > or =5 cm solitary tumor (P = .0095), and for the presence of a tumor capsule (P = .0012), within the Milan criteria (P = .0376). At multivariate analysis, significant independent predictors for HCC recurrence were microvascular tumor embolism and histopathologic grade. In conclusion, microvascular tumor embolism is an independent predictor of HCC recurrence after liver transplantation. Although OLT is a safe and effective treatment for HCC within the Milan criteria, the presence of microvascular tumor embolism at pathologic examination can predict its recurrence. In these cases, the feasibility of immunosuppressive therapy or adjuvant chemotherapy must be considered to prevent tumor recurrence.     

肝移植治疗肝细胞型肝癌的67例临床分析

目的探讨肝移植治疗肝细胞型肝癌的临床价值及影响预后的因素。方法对67例接受肝移植治疗、且随访时间≥6个月的肝细胞型肝癌患者的临床资料进行回顾性分析。结果67例患者肝移植术后1年、2年存活率分别为89.96%、65.59%,1年、2年无瘤存活率分别为77.51%、62.49%;单因素分析显示,甲胎蛋白水平、肿瘤最大直径、门静脉癌栓、肿瘤累及肝脏左右两叶、肿瘤分化程度和肿瘤TNM分期是影响无瘤存活率的重要因素,Cox风险模型多因素分析显示,肿瘤最大直径和门静脉癌栓是影响无瘤存活率的独立危险因素。结论肝移植是目前治疗肝细胞型肝癌的有效方法,肿瘤直径>5cm和门静脉癌栓严重影响患者的无瘤存活率。     

Antiviral prophylaxis and recurrence of hepatocellular carcinoma following liver transplantation in patients with hepatitis B

BACKGROUND: Orthotopic liver transplantation (OLT) is a viable treatment option for patients with hepatitis B (HBV) and concomitant hepatocellular carcinoma (HCC). However, cancer recurrence following transplantation approaches 20%. This study sought to identify the clinical and pathological factors associated with post-OLT survival. METHODS: Univariate and multivariate analyses considered the following variables: combination viral prophylaxis, HBV recurrence, tumor stage, vascular invasion, distribution, nodularity, pre- and post-OLT tumor size, pre-OLT alpha-fetoprotein (AFP), Milan and UCSF criteria, and Asian race. RESULTS: Cumulatively, HCC recurrence-free survival was 77%, 62%, and 53% at 1, 3, and 5 years, respectively, and was significantly better in patients who were free of viral recurrence post-OLT. Similarly, patients treated with combination prophylaxis had a significantly lower mortality than those who were not. CONCLUSIONS: Multivariate analysis revealed that AFP>500 ng/mL, presence of vascular invasion by explant, HBV recurrence, and combination prophylaxis were independent predictors of HCC recurrence-free survival.     

Liver transplantation for hepatocellular carcinoma in patients without underlying liver disease: a systematic review.

Liver resection is the treatment of choice for hepatocellular carcinoma (HCC) occurring in the absence of underlying chronic liver disease. Orthotopic liver transplantation (OLT) is reserved for patients with unresectable disease but remains controversial. The aim of this study was to review the published literature on OLT for HCC in patients without coexisting chronic liver disease. A Medline-based search identified 126 patients reported in 16 papers over the last 32 years. One third had fibrolamellar HCC (FL-HCC), and two thirds had non-FL-HCC. Recurrence data were given in 55 patients of whom 27 had tumor recurrence. Seventy-five percent of the recurrences occurred within the first 2 years after OLT, although recurrences were reported up to 72 months after OLT for FL-HCC. The 5-year survival rate was greater in patients who underwent transplantation for FL-HCC than for non-FL-HCC (39.4% and 11.2%, respectively). There was insufficient information available to determine the influence of tumor size, distribution, stage, and vascular invasion on survival, although most patients in whom tumor characteristics were specified had advanced disease. This study indicates that FL-HCC carcinoma is a more favorable indication for OLT than non-FL-HCC in patients without underlying liver disease, although more detailed prognostic information is required to improve patient selection.     

Predictors of survival after liver transplantation for hepatocellular carcinoma associated with Hepatitis C.

The efficacy of orthotopic liver transplantation (OLT) for hepatocellular carcinoma (HCC) associated with hepatitis C virus (HCV) is not well defined. This study examines the variables that may determine the outcome of OLT for HCC in HCV patients. From 1990 to 1999, 463 OLTs were performed for HCV cirrhosis. Of these patients, 67 with concurrent HCC were included in the study. Univariate and multivariate analyses considered the following variables: gender, pTNM stage, tumor size, number of nodules, vascular invasion, incidental tumors, adjuvant chemotherapy, preoperative chemoembolization, alpha-fetoprotein (AFP) tumor marker, lobar distribution, and histological grade. Overall OLT survival of HCV patients diagnosed with concomitant HCC was significantly lower when compared to patients who underwent OLT for HCV alone at 1, 3, and 5 years (75%, 71%, and 55% versus 84%, 76%, and 75%, respectively; P < 0.01). Overall survival of patients with stage I HCC was significantly better than patients with stage II, III, or IV (P < .05). Eleven of 67 patients developed tumor recurrence. Sites of recurrence included transplanted liver (5), lung (5), and bone (1). Twenty-four of 67 patients (36%) died during the follow-up time. Causes of deaths included recurrent HCC in 8 of 24 patients (12%) and recurrent HCV in 3 of 24 patients (4.5%), whereas 13 (19.5%) patients died from causes that were unrelated to HCV or HCC. Both univariate and multivariate analysis demonstrated that pTNM status (I versus II, III, and IV; P < .05) was a reliable prognostic indicator for patient survival. Presence of vascular invasion (P = .0001) and advanced pTNM staging (P = .038) increased risk of recurrence. Multivariate analysis showed that pretransplant chemoembolization and adjuvant chemotherapy reduced risk of death after OLT in HCC recipients. In conclusion, this study demonstrates the effectiveness of OLT for patients with HCC in a large cohort of chronic HCV patients. Advanced tumor stage, and particularly vascular invasion, are poor prognostic indicators for tumor recurrence. Early pTNM stage, adjuvant chemotherapy, and preoperative chemoembolization were associated with positive outcomes for patients who underwent OLT for concomitant HCV and HCC.     

Predictors of microvascular invasion in patients with hepatocellular carcinoma who are candidates for orthotopic liver transplantation

Microvascular invasion affects survival after orthotopic liver transplantation (OLT) for hepatocellular carcinoma (HCC). We sought to identify preoperative predictors of microvascular invasion in patients with HCC who were candidates for OLT. A cohort of 245 patients who underwent resection for HCC and fulfilled the criteria for OLT (i.e., single tumors ≤5 cm or no more than three tumors S3 cm) were identified from a multi-institutional database. Thirty-three percent of the patients had pathologic evidence of microvascular invasion. Thirty percent of patients with single tumors and 47% with multiple tumors had microvascular invasion (P = 0.04). Only 25% of patients with tumors smaller than ≤2 cm had microvascular invasion, compared to 31% and 50% with tumors greater than 2 to 4 cm or larger than 4 cm, respectively (P = 0.01). Tumor grade was highly correlated with microvascular invasion: 12% of patients with well-differentiated tumors had microvascular invasion, compared to 29% and 50% with moderately or poorly differentiated tumors, respectively (P < 0.001). The independent predictors of microvascular invasion were tumor size greater than 4 cm (odds ratio [OR], 3.0, 95% confidence interval [CI], 1.2 to 7.1), and high tumor grade (OR, 6.3; 95% CI, 2.0 to 19.9). Tumor size and grade are strong predictors of microvascular invasion. A tumor biopsy with pathologic grading at the time of pretransplantation ablative therapy could improve selection of patients with HCC for OLT. Presented at the Forty-Second Annual Meeting of The Society for Surgery of the Alimentary Tract, Atlanta, Georgia, May 20–23, 2001. Supported by a T-32 Surgical Oncology Training Grant from the National Institutes of Health (N.F.E).     

Liver Transplantation for Hepatocellular Carcinoma: Validation of the UCSF-Expanded Criteria Based on Preoperative Imaging

We previously suggested that in patients with heptocellular carcinoma (HCC), the conventional Milan criteria (T1/T2) for orthotopic liver transplantation (OLT) could be modestly expanded based on pathology (UCSF criteria). The present study was undertaken to prospectively validate the UCSF criteria based on pretransplant imaging. Over a 5-year period, the UCSF criteria were used as selection guidelines for OLT in 168 patients, including 38 patients exceeding Milan but meeting UCSF criteria (T3A). The 1- and 5-year recurrence-free probabilities were 95.9% and 90.9%, and the respective survivals without recurrence were 92.1% and 80.7%. Patients with preoperative T1/T2 HCC had 1- and 5-year recurrence-free probabilities of 95.7% and 90.1%, respectively, versus 96.9% and 93.6%, respectively, for preoperative T3A stage (p = 0.58). Under-staging was observed in 20% of T2 and 29% of T3A HCC (p = 0.26). When explant tumor exceeded UCSF criteria (15%), the 1- and 5-year recurrence-free probabilities were 80.4% and 59.5%, versus 98.6% and 96.7%, respectively, for those within UCSF criteria (p < 0.0001). In conclusion, our results validated the ability of the UCSF criteria to discriminate prognosis after OLT and to serve as selection criteria for OLT, with a similar risk of tumor recurrence and under-staging when compared to the Milan criteria.     

Multifocal manifestation does not affect vascular invasion of hepatocellular carcinoma: implications for patient selection in liver transplantation

BACKGROUND AND AIMS: Liver transplantation (OLT) for hepatocellular carcinoma (HCC) improves patient survival when tumor size and number are limited according to the Milan criteria. However, the impact of tumor size vs. the number of lesions for tumor recurrence after OLT is unclear. Microvascular invasion appears to be a significant risk factor for tumor recurrence. Therefore, it was the aim of this study to investigate tumor differentiation and microvascular invasion in relation to tumor number and size and their impact on survival after transplantation. PATIENTS AND METHODS: In 97 adult HCC patients who underwent OLT between June 1985 and December 2005 the incidence of microvascular invasion, tumor differentiation, and the number and size of tumor lesions were analyzed retrospectively. Their impact on survival was studied by multivariate analysis. RESULTS: Microvascular invasion was the only independent negative predictor of survival after OLT for HCC (p = 0.025). Tumor size > 5 cm was predictive for microvascular invasion (p = 0.007). In contrast, tumor number did not affect the incidence of microvascular invasion or cumulative survival. CONCLUSION: The size of the largest HCC lesion, but not the number of tumors, determined microvascular invasion, a predictor of the outcome following OLT for HCC. Thus, the number of HCC lesions should not be applied to patient selection prior to OLT. These data support the extension of the Milan criteria for the selection of HCC patients for OLT with regard to tumor number, but not tumor size.