再次肝移植治疗首次肝移植术后肝癌肝内复发的效果分析

目的 探讨肝癌肝移植术后复发肝癌的病理特点及再次肝移植治疗的意义及其预后.方法 回顾性分析肝移植术后21例肝癌复发患者的临床资料,其中9例接受再次肝移植治疗,12例行姑息治疗.所有患者原发病均为乙型肝炎后肝硬化合并肝癌,肝移植术后肿瘤均为肝内复发,无法局部切除.结果 9例患者首次和再次肝移植时肿瘤病理分析,肿瘤均为肝细胞肝癌,最大肿瘤直径分别平均为6.2 cm和4.8 cm,多发肿瘤者分别占67％和89％,有微血管侵犯者分别占100％和56％,肿瘤分化为Ⅱ级、Ⅲ级和Ⅳ级者分别为33％、67％、0和22％、22％、56％,复发肝脏肿瘤的平均最大直径和分化程度与原发肝脏肿瘤比较,差异均有统计学意义(P＜0.01).首次肝移植术后再次移植组患者无瘤存活时间中位数为15.0个月,再次肝移植术后无瘤存活时间中位数为2.5个月,再次移植术后存活时间中位数为5.8个月,总体存活时间中位数为21.8个月;姑息治疗组受者肝移植术后无瘤存活时间中位数为13.0个月,总体存活时间中位数为17.6个月;再次移植组和姑息治疗组术后1、2、3年累积存活率分别为89％、44％、33％和91％、45％、9％,两组间存活率比较,差异无统计学意义(P＞0.05).结论 血管侵犯为肝癌复发的高危因素;复发肿瘤分化程度更低;首次肝移植术后肝癌肝内复发可能是术前和术中肿瘤全身播散的早期临床特点和局部表现,不建议再次肝移植治疗肝癌肝移植术后肝癌肝内复发.     

不同抗肿瘤治疗方法对肝癌肝移植术后复发转移的疗效比较

目的 分析不同抗肿瘤治疗方法对原发性肝癌(肝癌)肝移植术后复发转移的疗效.方法 回顾性分析145例肝癌肝移植受者的临床资料.分析肝癌肝移植受者术后总体生存情况及复发转移情况.比较不同抗肿瘤治疗方法治疗复发转移受者的效果.结果 65例受者(44.8％)发生了复发转移,中位复发时间为6个月.其中1例复发后再次行肝移植,因肠...     

再次肝移植的原因与预后分析

目的探讨再次肝移植的原因和预后。方法回顾性分析2003年11月26日至2012年5月26日期间笔者所在医院行再次肝移植215例患者的临床资料,分析其再次肝移植的原因与预后。结果笔者所在医院完成再次肝移植215例,其中行2次肝移植200例,3次肝移植14例,4次肝移植1例。第2次肝移植的主要原因为胆道并发症（53.5%,115/215）,其次为肝移植物原发性无功能或功能低下（8.4%,18/215）;第3次肝移植的原因主要为胆道并发症（5/14）,其次为肝癌复发（2/14）。早期（肝移植术后1个月内）与后期（肝移植术后1个月后）第2次肝移植移植物生存率比较差异有统计学意义（P=0.005）,后期第2次肝移植移植物生存率较高。第3次肝移植移植物生存率低于第2次肝移植（P=0.043）。与胆道并发症者比较,肝癌复发者（P=0.001）和肝移植物原发性无功能或功能低下者（P=0.033）移植物生存率较低,慢性移植肝失功能者移植物生存率较高（P=0.037）。结论胆道并发症为再次肝移植的最主要原因。移植后早期行再次肝移植的效果不佳,其主要原因是围手术期的死亡增加。因肝癌复发而行再次肝移植患者移植物的预后不理想,而慢性移植肝失功能患者移植物的预后最佳。     

原发性肝癌切除术后复发的肝移植治疗

目的探讨原发性肝癌切除术后复发病人的肝移植手术指征和注意事项。方法总结2003年7月至2005年8月59例因肝癌接受肝移植的临床资料，其中肝癌切除术后复发12例（复发组），移植术前未接受手术治疗47例（对照组），分析两组病人移植术前肝功能、治疗情况、术中探查、手术时间、无肝期时间、出血量以及术后恢复情况。结果复发组病人移植手术时间、术中出血量及输血量均明显大于对照组，但两组无肝期时间以及1、2年存活率（75％vs．86％，P〉0．05；70．8％vs．83，3％，P〉0．05）差异无显著性意义。结论肝移植是肝癌切除术后复发病人的有效治疗方法，合理掌握肝移植指征是治疗肝癌切除术后复发的关键。     

原发性肝癌肝切除术后复发患者的肝移植治疗

目的观察肝移植治疗原发性肝癌肝切除术后复发患者的疗效。方法回顾性分析11例原发性肝癌肝切除术后复发接受经典原位肝移植治疗的受者的临床资料,观察移植效果。结果在围手术期,1例术后发生移植肝功能不全和凝血功能障碍并发肾功能衰竭死亡;1例术后出现急性胰腺炎,给予生长抑素治疗10d缓解;2例发生急性排斥反应,行大剂量甲泼尼龙冲击治疗3d逆转。10例受者顺利出院。出院后,3例分别于术后第5个月、第7个月、第19个月死于肝癌复发,1、2年受者存活率分别为72．7％（8／11）和63．6％（7／11）,至今最长存活的1例已达4年余。获长期存活的受者肝癌肝切除术前原发病均为小肝癌,肝切除术后复发行肝移植时肝癌均符合Milan标准。结论小肝癌行肝癌肝切除术后应密切随访,如发现肝癌复发且符合Milan标准可考虑行肝移植治疗,患者仍有可能获较长时间生存。     

肝移植术后肝癌复发转移患者的治疗及其预后分析

目的 总结肝癌患者行肝移植术后复发、转移的治疗方法,探讨其疗效,分析影响复发、转移后生存时间的危险因素.方法 本研究回顾性分析1999年1至2011年9月第三军医大学西南医院收治的行肝癌肝移植患者的临床资料.99例患者肝移植术后发生肝癌复发、转移,其中7例因不符合本研究标准予以剔除,最终纳入92例患者的临床资料,根据治疗方案将患者分为单一治疗组(18例)和综合治疗组(74例).比较两组患者的生存时间,并分析影响肝癌复发、转移患者预后的危险因素.计量资料比较采用t检验,计数资料采用x2检验或Fisher确切概率法.采用Kaplan-Meier法绘制生存曲线,生存分析采用Log-rank检验,患者预后因素采用多元线性回归分析.结果 单一治疗组和综合治疗组患者肝癌复发、转移后生存时间分别为(5.5±1.1)个月和(8.5±1.6)个月,两组比较,差异有统计学意义(Log-rank值为7.489,P＜0.05).92例患者中,TNM分期Ⅱ期和ⅢA期患者肝癌复发、转移后生存时间为(7.9±1.5)个月,ⅢB期和ⅣA期患者为(7.0±1.3)个月,两者比较,差异有统计学意义(Log-rank值为2.567,P＜0.05).分化程度:高、中分化患者肝癌复发、转移后生存时间为(8.1±1.5)个月,低分化患者为(7.2±1.4)个月,两者比较,差异有统计学意义(Log-rank值为2.749,P＜0.05).多元线性回归分析结果表明:肿瘤TNM分期、肿瘤分化程度、是否符合米兰标准、是否合并大血管侵犯是影响患者肝癌复发、转移后生存时间的独立危险因素(t =2.610,3.132,4.378,2.258,P＜0.05).结论 综合治疗可明显延长肝癌复发、转移后患者的生存时间.肝移植术后患者肝癌复发、转移发生时间越早,恶性程度越高,生存时间越短.肿瘤TNM分期、肿瘤分化程度、是否符合米兰标准、是否合并大血管侵犯是影响患者生存时间的危险因素.     

不同肝癌肝移植标准对于肝癌切除术后复发补救性肝脏移植有效性的评价

目的 评价米兰标准、UCSF标准、Up-to-seven标准作为肝癌切除术后复发补救性肝移植适应症选择标准的有效性.方法 回顾性分析本治疗组自1999年6月至2011年6月间实施的724例肝癌肝脏移植病例数据,其中包括107例肝癌切除术后复发行补救性肝移植术病例,对不同选择标准在各组病例的生存率进行统计分析.结果 对于首选肝脏移植患者米兰标准、UCSF标准、Up-to-seven标准具有良好的一致性,5年生存率分别为76.2％,75.5％,73.4％.对于补救性肝脏移植,米兰标准、UCSF标准具有与首选肝脏移植一致的有效性,受者术后5年生存率分别83.1％,72.6％;而Up-to-seven标准则不具有一致的有效性,符合该标准的补救性肝脏移植受者5年生存率仅为49.9％,不符合Up-to-seven标准补救性肝脏移植受者的5年生存率为49.4％,二者无统计学差异.结论 米兰标准、UCSF标准对于肝癌切除术后复发补救性肝移植适应症的选择具有较好的有效性,Up-to-seven标准有效性则较低;对于补救性肝癌肝移植应进行三维变量的标准选择,包括首次肝切除时肝癌数据、补救性肝脏移植评估时复发肝癌数据以及肝癌切除术后复发的时间间隔.     

挽救性肝移植治疗肝癌切除术后肿瘤复发

目的 分析挽救性肝移植治疗肝癌切除术后肿瘤复发患者的疗效.方法 2004年1月至2008年12月,单中心376例肝癌患者接受了肝移植,其中36例(9.6 %)为行根治性肿瘤切除术后因肿瘤肝内复发而接受挽救性肝移植者(挽救性肝移植组).挽救性肝移植组中男性29例,女性7例;16例接受右半肝切除,10例接受左半肝切除,其余10例接受不规则肝切除或肝段切除.首次肝切除至行挽救性肝移植的时间为(34.9±16.2)个月(1～63个月).以同期符合米兰标准并接受首次肝移植的147例作为对照组,比较两组受者的术中情况及术后生存情况、肿瘤复发情况等.结果 挽救性移植组术中出血量和输血量明显多于对照组(P＜0.05),手术时间也长于对照组(P＜0.05).随访期间,挽救性肝移植组死亡11例,其中围手术期死亡1例;对照组共死亡36例,其中围手术期死亡3例.两组手术后并发症、肿瘤复发率、受者存活率以及无瘤存活率的差异无统计学意义(P＞0.05).结论 挽救性肝移植虽然较首次肝移植手术难度增加,但不影响患者预后,是根治性肝癌切除术后肿瘤复发患者的有效治疗手段.

Abstract：

Objective To summarize the experience with salvage liver transplantation for patients with recurrent hetaptocellular carcinoma(HCC)after primary liver resection.Methods From 2004 to 2008,376 patients with HCC received liver transplantation in our single center.Among these patients,36 (9.6 %)underwent salvage liver transplantation after primary liver curative resection due to intrahepatic recurrence.There were 29 males and 7 females with the mean age of 46 years old.Sixteen received right lobectomy,10 received left lobectomy and the others received sectionectomy or segmentectomy.As a control group for comparison,we used clinical data of the 147 patients who underwent primary OLT for HCC within Milan Criteria.Results The mean interval between initial liver resection and salvage transplantation was 34.9±16.2 months(1-63 months).Intraoperative bleeding volume,transfusion volume and operative time in the salvage group were significantly different from those in control group (P<0.05).There were no significant difference in post-operative complications,tumor recurrence rate,survival rate and tumor-free survival between these two groups(P>0.05).Conclusion In comparison with primary OLT,although salvage liver transplantation would increase the operation difficulties,it still remains a good option for patients with HCC recurrence after curative resection.     

肝癌肝移植术后肿瘤复发相关蛋白的鉴定及生物信息学分析

目的 鉴定肝癌肝移植术后肿瘤复发相关蛋白并进行相关生物信息学分析.方法 取肝癌肝移植术后3年患者原发瘤标本,根据肿瘤复发情况,分为复发组(10例)和未复发组(10例).用双向电泳对两组总蛋白进行分离,质谱鉴定差异蛋白;用Gene Ontology和MetaCore软件进行生物信息学分析;用蛋白印迹法测定核纤层蛋白A/C(lamin A/C)的表达.结果 共鉴定出37个差异蛋白,相对于未复发组,复发组中表达上调2倍以上的蛋白16个,表达下调2倍以上的蛋白21个.按Gene Ontology进行分类发现它们主要分布于细胞浆(27％)和细胞器(24％);主要参与体内催化反应(38％)和结合反应(24％)等生物学功能.MetaCore数据库分析,发现多种蛋白参与细胞凋亡、细胞死亡、细胞发育过程的信号调控网络.我们应用蛋白免疫印迹对lamin A/C在两组间的差异表达情况进行了再验证,验证结果与质谱结果吻合.结论 肝癌肝移植术后转移复发与多种蛋白表达改变相关,lamin A/C可能为移植后肿瘤转移复发的潜在分子靶点.     

肝癌肝移植受者一年内致死性复发风险因素分析

目的 分析影响肝细胞癌肝移植术后一年内因转移复发死亡的临床病理学风险因素.方法 回顾性分析2002年4月至2005年4月间武警总医院器官移植研究所303例肝细胞肝癌行肝移植病人一年内因转移复发而死亡受者(致死性复发组)的临床病理资料,与未复发或复发但未在一年内死亡的受者(对照组)比较,采用logistic回归分析探讨l临床病理学风险因素对一年生存率的影响.结果 303例病人中有48例在一年内因转移复发死亡(死亡率15.84%),多因素分析显示肿瘤血管浸润、直径≥6.5 cm和移植术前血清AFP≥1000 μg/L是致死性复发的独立风险因素.同时具备上述三种风险因素受者一年内致死性复发85.71%,同时具有2项以上风险者37.84%,具备其中一项风险因素者13.64%,不具备三种中任何一种风险因素者致死性复发发生率为6.71%.结论 三种导致肝细胞肝癌病人在手术后一年内因肿瘤复发转移死亡的主要危险因素是肿瘤血管浸润、直径≥6.5 cm和移植术前血清AFP≥1000 μg/L.同时具备2个或2个以上的致死性复发的临床病理学风险病人不适宜作为肝移植的适应证.     

Liver transplantation and waitlist mortality for HCC and non‐HCC candidates following the 2015 HCC exception policy change

Historically, exception points for hepatocellular carcinoma (HCC) led to higher transplant rates and lower waitlist mortality for HCC candidates compared to non‐HCC candidates. As of October 2015, HCC candidates must wait 6 months after initial application to obtain exception points; the impact of this policy remains unstudied. Using 2013‐2017 SRTR data, we identified 39  350 adult, first‐time, active waitlist candidates and compared deceased donor liver transplant (DDLT) rates and waitlist mortality/dropout for HCC versus non‐HCC candidates before (October 8, 2013‐October 7, 2015, prepolicy) and after (October 8, 2015‐October 7, 2017, postpolicy) the policy change using Cox and competing risks regression, respectively. Compared to non‐HCC candidates with the same calculated MELD, HCC candidates had a 3.6‐fold higher rate of DDLT prepolicy (aHR = _3.49 3.69 _3.89) and a 2.2‐fold higher rate of DDLT postpolicy (aHR = _2.09 2.21 _2.34). Compared to non‐HCC candidates with the same allocation priority, HCC candidates had a 37% lower risk of waitlist mortality/dropout prepolicy (asHR = _0.54 0.63 _0.73) and a comparable risk of mortality/dropout postpolicy (asHR = _0.81 0.95 _1.11). Following the policy change, the DDLT advantage for HCC candidates remained, albeit dramatically attenuated, without any substantial increase in waitlist mortality/dropout. In the context of sickest‐first liver allocation, the revised policy seems to have established allocation equity for HCC and non‐HCC candidates.     

Treatment of HCC in Patients Awaiting Liver Transplantation

Liver transplantation (LT) is the treatment of choice for many patients with unresectable hepatocellular carcinoma (HCC), but long waiting time due to the shortage of donor organs can result in tumor progression and drop-out from LT candidacy. Furthermore, even in candidates meeting the restrictive Milan criteria there is risk of HCC recurrence; this risk rises significantly when patients with more advanced HCC are included. In an effort to address these issues, treatment of HCC in patients awaiting LT has become widespread practice. In this review the various modalities employed in the pre-LT setting are presented, and the evidence for benefit with regard to (1) improvement of post-LT survival, (2) down-staging of advanced HCC to within Milan criteria and (3) preventing waiting list drop-out is considered. Chemoembolization, radiofrequency ablation and ethanol injection all have well-documented antitumor activity; however, there is no high level evidence that waiting list HCC treatment with these modalities is effective in achieving any of the three above-mentioned aims. Nevertheless, particularly in the United States, where continued waiting list priority depends on maintaining HCC within Milan criteria, use of nonsurgical HCC treatment will likely continue in an effort to forestall tumor progression and waiting list drop-out.     

腹腔镜肝切除术治疗复发性肝癌的围手术期和近期疗效观察

目的 本研究基于倾向评分匹配（PSM）对比腹腔镜肝切除术（LLR）和开腹肝切除术（OLR）治疗复发性肝细胞癌（rHCC）的围手术期和近期疗效,探讨其治疗安全性、有效性和临床应用价值。方法 回顾性分析2017年1月至2021年12月在温州市人民医院接受手术治疗的49例rHCC患者,按照手术方式分为LLR组（27例）和OLR组（22例）,通过倾向性评分匹配（PSM）筛选出34例用于数据分析,比较两组的临床基本资料、围手术期结果和术后复发情况。结果 PSM前,OLR组肿瘤大小、术中出血量和输血量、术后并发症发生率、住院时间均明显高于LLR组（P<0.05）。PSM后,两组在肿瘤大小、术中输血量和术后并发症发生率方面均无统计学差异,但LLR组术中出血量和术后住院时间明显少于OLR组（P<0.05）。两组无复发生存期（RFS）差异无统计学意义（P=0.383）。结论 LLR治疗rHCC可减少术中出血量和输血量,减少并发症发生率,缩短住院时间,围手术期和近期疗效优于OLR。在严格掌握手术适应证的前提下,LLR具有良好的安全可行性。     

TACE联合PEI治疗原发性肝癌血液循环性肝癌细胞的变化及意义

目的：探讨联合经肝动脉化疗栓塞术(TACE)及B超引导下肿瘤局部无水酒精注射术(PEI),治疗原发性肝癌周围静脉血液循环性肝癌细胞的变化及其意义.方法:应用巢式RT-PCR检测12例原发性肝癌患者血液循环性肝癌细胞,并经TACE及PEI联合治疗,观察其血液循环性肝癌细胞的变化.结果:血液循环性肝癌细胞表达阳性的5例原发性肝癌患者(41.67%),经TACE及PEI联合治疗后,其血液循环性肝癌细胞均转为阴性(100%,P<0.01).结论:联合TACE及PEI治疗原发性肝癌可有效地杀灭血液中播散的循环性肝癌细胞,可预防肝癌的复发和转移.     

HCC Patients Suffer Less From Geographic Differences in Organ Availability

It has been suggested that the number of exception model for end‐stage liver disease (MELD) points for hepatocellular carcinoma (HCC) overestimates mortality risk. Average MELD at transplant, a measure of organ availability, correlates with mortality on an intent‐to‐treat basis and varies by donation service area (DSA). We analyzed Scientific Registry of Transplant Recipients data from 2005 to 2010, comparing transplant and death parameters for patients transplanted with HCC exception points to patients without HCC diagnosis (non‐HCC), to determine whether the two groups were impacted differentially by DSA organ availability. HCC candidates are transplanted at higher rates than non‐HCC candidates and are less likely to die on the waitlist. Overall risk of death trends downward by 1% per MELD point (p = 0.65) for HCC, but increases by 7% for non‐HCC patients (p < 0.0001). The difference in the change of mortality with MELD is statistically significant between HCC and non‐HCC candidates p < 0.0001. Posttransplant risk of death trends downward by 2% per MELD point (p = 0.28) for HCC patients, but increases by 3% per MELD point in non‐HCC patients (p = 0.027), with the difference being statistically significant with p < 0.005. In summary, increasing wait time impacts HCC candidates less than non‐HCC candidates and under increased competition for donor organs, HCC candidates' advantage increases.     

HDAC抑制剂SAHA对人肝癌细胞分化诱导作用的研究

目的 探讨组蛋白去乙酰化酶(histone deacetylases,HDAC)抑制剂SAHA(suberoylanilide hydroxamic acid)对人肝癌SMMC-7721细胞的分化诱导作用.方法 倒置显微镜观察SAHA对SMMC-7721细胞形态的影响;MTT比色法测定SAHA对SMMC-7721细胞增殖的抑制情况;免疫细胞化学检测SAHA对SMMC-7721细胞中甲胎蛋白(AFP)和增殖细胞核抗原(PCNA)表达的影响;流式细胞术(FCM)分析细胞周期;RT-PCR方法榆测处理前后SMMC-7721细胞p21WAF1基因mRNA的表达变化.结果 实验组细胞增殖速度显著减慢,与正常细胞形念变化相似;MTT比色法测定结果显示不同浓度SAHA对SMMC-7721细胞的增殖均有抑制作用,并有明显的剂量依赖和时间依赖关系;免疫细胞化学检测显示SAHA能显著降低PCNA和AFP在SMMC-7721细胞中的表达;流式细胞仪检测结果显示,SMMC-7721细胞经SAHA处理后,G0/G1期细胞明显增加,S期细胞则明显减少,细胞被阻滞于G0/G1期;RT-PCR检测结果表明,实验组细胞中p21WAF1 mRNA的表达明显增加.结论 SAHA对人肝癌细胞具有显著的诱导分化作用,诱导肝癌细胞分化的机理可能与抑制HDAC的活性,上调p21 WAF1 mRNA表达,及阻滞肝癌细胞G0/G1期有关.     

Beyond Milan criteria – chances and risks of expanding transplantation criteria for HCC patients with liver cirrhosis

Abstract:  Orthotopic liver transplantation (OLT) is, apart from resection, one important curative treatment for hepatocellular carcinoma (HCC) in liver cirrhosis, and especially attractive because it eliminates both the tumor and the underlying liver disease. The application of restrictive inclusion criteria for OLT in HCC patients resulted in favorable long-term recurrence-free survival. These criteria, however, exclude a subgroup of patients which, despite advanced tumor size, demonstrate an acceptable outcome. As a consequence, expansion of the strict Milan criteria has been discussed. However, this will also deteriorate the average outcome of OLT in HCC patients. Considering that we run short of donor organs, more sophisticated prediction models for survival after OLT for HCC patients are needed to identify patients who benefit best from OLT. Neoadjuvant treatment that is frequently applied as a bridging technique for patients on the waiting list for OLT could provide useful information on tumor behavior to better predict the risk of post-OLT tumor recurrence. This might also allow expansion of the Milan criteria to patients with good response to downstaging methods without negatively affecting post-OLT survival. Furthermore, alternative scoring systems have been suggested to identify HCC patients that might still benefit from resection instead of OLT, and molecular tools are being explored to provide predictive information on HCC biology. This review discusses the advantages and risks of extended inclusion criteria for OLT and the currently available data on alternative prediction models and bridging methods in HCC patients.     

不同评分系统评估肝癌患者行肝切除术围手术期风险的临床价值

目的比较Child-Pugh分级、终末期肝病模型（MELD）评分、慢性肝功能障碍评分（CLD）在肝癌患者行肝切除术围手术期风险评估中的应用价值。 方法回顾性分析141例肝切除术肝癌患者的临床资料,术前分别计算Child-Pugh分级、MELD评分及CLD评分,并分析3种评分与术后肝功能不全发生率的关系,对比不同肝功能恢复组的Child-Pugh、MELD、CLD评分。 结果①Child-Pugh A级与B级者的肝功能不全发生率差异无统计学意义,而MELD≤14分者与>14分者、CLD≤1.0分者与>1.0分者的发生率差异均有统计学意义(χ²=10.187、12.322,P<0.05);②肝功能恢复良好组、肝功轻度不全组的Child-Pugh评分差异无统计学意义,而肝功能恢复良好组、肝功轻度不全组、肝功能重度不全组的MELD评分及CLD评分均依次递增（P<0.05）;③CLD评分、MELD评分、Child-Pugh分级的ROC-AUC依次递增（P<0.05）;④在特异度95%时,CLD评分的敏感度最高,MELD评分次之,Child-Pugh分级最低（P<0.05）。 结论较之于目前普遍使用的Child-Pugh分级,MELD评分、CLD评分均可较准确地预测肝切除术后肝功能不全的发生情况,但CLD评分的准确性、敏感度更高,更符合我国肝病特点。     

Non-Resective Ablation and Liver Transplantation in Patients with Cirrhosis and Hepatocellular Carcinoma (HCC): Safety and Efficacy

We investigated the efficacy of nonresective ablation techniques and the tumor-free survival of cirrhotic patients undergoing liver transplantation for hepatocellular carcinoma (HCC). In group 1, 11 HCC patients were treated with these techniques and transplanted. On the waiting list, patients were treated to complete ablation, judged by gadolinium-enhanced MRI and alpha-fetoprotein (AFP) levels. Group 1 was compared with a concurrent group of 10 liver transplant patients (group 2) with incidental HCC (stages T1 three patients, T2 seven patients). The group 1 patients received 36 procedures (4 alcohol ablations, 14 trans -hepatic artery chemo-embolizations, 15 trans -hepatic chemo-infusions, and 3 radio frequency ablations) for treatment of 13 liver masses. Tumor-node-metastasis (TNM) stage was reduced in eight patients (72.7%), unchanged in two patients and increased in one patient before transplantation. The mean waiting time for transplantation was 12.9 7.6 months. Both groups had a tumor-free survival of 100%, at 30 12 months post transplant. On pathology, 54.5% of explanted livers had residual viable HCC after tumor treatment, and 36.4% (4/11) explants had synchronous lesions. Non-resective ablation therapy is safe and effective in reducing the HCC progression in cirrhotic patients awaiting liver transplantation. The cancer-free survival rate in this treatment group is equal to that for incidental T1-T2 HCCs.