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

Shimoda, Mitsugi, Ghobrial, Rafik M., Carmody, Ian C., Anselmo, Dean M., Farmer, Douglas G., Yersiz, Hasan, Chen, Pauline, Dawson, Sherfield, Durazo, Francisco, Han, Steve, Goldstein, Leonard I., Saab, Sammy, Hiatt, Jonathan and Busuttil, Ronald W. (2004) Predictors of survival after liver transplantation for hepatocellular carcinoma associated with hepatitis C. Liver Transplantation, 10 12: 1478-1486. doi:10.1002/lt.20303


Author Shimoda, Mitsugi
Ghobrial, Rafik M.
Carmody, Ian C.
Anselmo, Dean M.
Farmer, Douglas G.
Yersiz, Hasan
Chen, Pauline
Dawson, Sherfield
Durazo, Francisco
Han, Steve
Goldstein, Leonard I.
Saab, Sammy
Hiatt, Jonathan
Busuttil, Ronald W.
Title Predictors of survival after liver transplantation for hepatocellular carcinoma associated with hepatitis C
Journal name Liver Transplantation   Check publisher's open access policy
ISSN 1527-6465
1527-6473
Publication date 2004-12
Sub-type Article (original research)
DOI 10.1002/lt.20303
Volume 10
Issue 12
Start page 1478
End page 1486
Total pages 9
Place of publication Hoboken, NJ, United States
Publisher John Wiley & Sons
Language eng
Abstract 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 HC
Keyword Single-Center Experience
Virus-Infection
Cirrhotic-Patients
Tumor Size
Non-a
Resection
Recurrence
Chemotherapy
Impact
Japan
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Medicine Publications
 
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