Do Tumor Characteristics and Pre-Transplant Locoregional Therapy Predict Survival after OLT in Patients with Hepatocellular Carcinoma?

Abstract

HCC prognosis after OLT is associated with criteria related to the number and size. However, the degree of differentiation and efficacy of locoregional therapies may also influence outcome. Aim: Characterize patients with and without HCC and compare outcomes according to tumor characteristics. Methods: Retrospective query of an electronic medical record of 328 patients transplanted at California Pacific Medical Center (CPMC) in 2001-2007. HCC was defined by pre-OLT listing data as well as the finding of a tumor consistent with HCC at liver explant. Milan and UCSF criteria were applied to the lesions as described by pathology upon explant examination. Results: 328 patients were evaluated, with 109 liver malignancies, 103 females (26 (25%) HCC) and 225 males (83 (37%) HCC p = 0.04). HCC patients were older (56 ± 7.2 yr) than non HCC patients (51 ± 9.2, p < 0.001). The age of the donor and cold ischemia time was not different in the 2 groups. Survival was shorter in HCC (mean 984 ± 599 days) vs. non HCC (1103 ± 642) but not statistically significant (p = 0.10). Kaplan Meier survivals were superposable when comparing patients with or without malignancy and when patients with low (≤22) vs. high MELD (>22) were compared. Survival curves in patients that fulfilled Milan vs. UCSF criteria were identical. However, more patients outside Milan died of metastatic disease (5/6, 83%) vs. within Milan (6/14, 43%, p = 0.01). Cox proportional hazards regression showed that MELD, but not malignancy, differentiation or necrosis, was associated with mortality; HR = 6% (95% C.I. 1%-10%) per additional MELD point (p = 0.02). 69 pts had TACE pre-OLT, 17 had RFA ± any other modality. There was no difference in survivals in pts who received any locoregional therapy vs. those who did not (p

Share and Cite:

M. Kohla, R. Shaw, G. Hisatak, R. Osorio and M. Bonacini, "Do Tumor Characteristics and Pre-Transplant Locoregional Therapy Predict Survival after OLT in Patients with Hepatocellular Carcinoma?," International Journal of Clinical Medicine, Vol. 4 No. 12A, 2013, pp. 25-31. doi: 10.4236/ijcm.2013.412A1006.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] M. Shimoda, R. M. Ghobrial, I. C. Carmody, et al., “Predictors of Survival after Liver Transplantation for Hepatocellualr Carcinoma Associated with Hepatitis C,” Liver Transplantation, Vol. 10, No. 12, 2004, pp. 1478-1486.
http://dx.doi.org/10.1002/lt.20303
[2] B. Ringe, R. Pichlmayr, C. Wittekind, et al., “Surgical Treatment of Hepatocellular Carcinoma: Experience with Liver Resection and Transplantation in 198 Patients,” World Journal of Surgery, Vol. 15, No. 2, 1991, pp. 270-285. http://dx.doi.org/10.1007/BF01659064
[3] S. Iwatsuki, T. E. Starzl, D. G. Sheahan, et al., “Hepatic Resection versus Transplantation for Hepatocellular Carcinoma,” Annals of Surgery, Vol. 214, No. 3, 1991, pp. 221-228. http://dx.doi.org/10.1097/00000658-199109000-00005
[4] H. Bismuth, L. Chiche, R. Adam, et al., “Surgical Treatment of Hepatocellular Carcinoma in Cirrhosis: Liver Resection or Transplantation?” Transplantation Proceedings, Vol. 25, No. 1, 1993, pp. 1066-1067.
[5] Y. Muto, H. Moriwaki, M. Ninomaya, et al., “Prevention of Second Primary Tumors by an Acyclic Retinoid, Polyprenoic Acid, in Patients with Hepatocellular Carcinoma,” The New England Journal of Medicine, Vol. 334, No. 24, 1996, pp. 1561-1567.
http://dx.doi.org/10.1056/NEJM199606133342402
[6] W. Y. Lau, T. W. Leung, S. K. Ho, et al., “Adjuvant intra-Arterial Iodine-131-Labelled Lipiodol for Respectable hepatocellular Carcinoma: A Prospective Randomized Trial,” Lancet, Vol. 353, No. 9155, 1999, pp. 797-801.
http://dx.doi.org/10.1016/S0140-6736(98)06475-7
[7] J. M. Llovet, J. Fuster and J. Bruix, “Intention-to-Treat Analysis of Surgical Treatment for Early Carcinoma: Resection versus Transplantation,” Hepatology, Vol. 30, No. 6, 1999, pp. 1434-1440.
http://dx.doi.org/10.1002/hep.510300629
[8] Z. Y. Tang, Y. Q. Yu and X. D. Zhou, “Evolution of Surgery in the Treatment of Hepatocellular Carcinoma from the 1950s to the 1990s,” Seminars in Surgical Oncology, Vol. 9, No. 4, 1993, pp. 293-297.
http://dx.doi.org/10.1002/ssu.2980090403
[9] M. Makuuchi, “Surgical Management for Hepatocellular Carcinoma,” In: V. Arroyo, J. Bosch and J. Rodēs, Eds., Treatments in Hepatology, Barcelona, Masson, Vol. 1995, pp. 341-352.
[10] The Liver Cancer Study Group of Japan, “Predictive Factors for Long Term Prognosis after Partial Hepatectomy for Patients with Hepatocellular Carcinoma in Japan,” Cancer, Vol. 74, No. 10, 1994, pp. 2772-2780.
http://dx.doi.org/10.1002/1097-0142(19941115)74:10<2772::AID-CNCR2820741006>3.0.CO;2-V
[11] B. Ringe, R. Pichlmyar, C. Wittekind, et al., “Surgical Treatment of Hepatocellular Carcinoma: Experience with Liver Resection and Transplantation in 198 Patients,” World Journal of Surgery, Vol. 15, No. 2, 1991, pp. 270-285. http://dx.doi.org/10.1007/BF01659064
[12] P. Moreno, E. Jaurrieta, J. Figueras, et al., “Orthotopic Liver Transplantation: Treatment of Choice in Cirrhotic Patients with Hepatocellular Carcinoma?” Transplantation Proceedings, Vol. 27, No. 4, 1995, pp. 2296-2298.
[13] H. Bismuth, L. Chiche, R. Adam, et al., “Liver Resection versus Transplantation for Hepatocellular Carcinoma in Cirrhotic Patients,” Annals of Surgery, Vol. 218, No. 2, 1993, pp. 145-151.
http://dx.doi.org/10.1097/00000658-199308000-00005
[14] D. G. Farmer, M. H. Rosove, A. Shaked, et al., “Current Treatment Modalities for Hepatocellular Carcinoma,” Annals of Surgery, Vol. 219, No. 3, 1994, pp. 236-247.
http://dx.doi.org/10.1097/00000658-199403000-00003
[15] H. Bismuth, P. E. Majno and R. Adam, “Liver Transplantation for Hepatocelluar Carcinoma,” Seminars in Liver Disease, Vol. 19, No. 3, 1999, pp. 311-322.
http://dx.doi.org/10.1055/s-2007-1007120
[16] G. B. Kliontmalm, “Liver Transplantation for Hepatocellular Carcinoma: A Registry Report of the Impact of Tumor Characteristics on Outcome,” Annals of Surgery, Vol. 228, No. 4, 1998, pp. 479-490.
http://dx.doi.org/10.1097/00000658-199810000-00005
[17] I. Penn, “Hepatic Transplantation for Primary and Metastatic Cancers of the Liver,” Surgery, Vol. 110, No. 4, 1991, pp. 726-734.
[18] I. Yokoyama, S. Todo, S. Iwatsuki, et al., “Liver Transplantation in the Treatment of Primary Liver Cancer,” Hepatogastroenterology, Vol. 37, No. 2, 1990, pp. 188-193.
[19] J. G. O’Grady, R. J. Polson, K. Rolles, et al., “Liver Transplantion for Malignant Disease. Results in 93 consecutive patients,” Annals of Surgery, Vol. 207, No. 4, 1988, pp. 373-379.
http://dx.doi.org/10.1097/00000658-198804000-00002
[20] H. Matsunami, Y. Shimizu, S. V. Lynch, et al., “Liver Transplantation as a Therapeutic Option for Hepatocellular Carcinoma,” Oncology, Vol. 62, Suppl. 1, 2002, pp. 82-86. http://dx.doi.org/10.1159/000048281
[21] V. Mazzaferro, E. Regalia, R. Doci, et al., “Liver Transplantation for the Treatment of Small Hepatocellular Carcinomas in Patients with Cirrhosis,” The New England Journal of Medicine, Vol. 334, No. 11, 1996, pp. 693-699. http://dx.doi.org/10.1056/NEJM199603143341104
[22] F. Y. Yao, L. Ferrell, N. M. Bass, et al., “Liver Transplantation for Hepatocellular Carcinoma: Expansion of the Tumor Size Limits Does Not Adversely Impact Survival,” Hepatology, Vol. 33, No. 6, 2001, pp. 1394-1403.
http://dx.doi.org/10.1053/jhep.2001.24563
[23] D. Y. Kim, M. S. Choi, J. H. Lee, et al., “Milan Criteria Are Useful Predictors for Favorable Outcomes in Hepatocellular Carcinoma Patients Undergoing Liver Transplantation after Chemoembolization,” World Journal of Gastroenterology, Vol. 12, No. 43, 2006, pp. 6992-6997.
[24] “United Network for Organ Sharing,” 2002.
http://www.unos.org
[25] F. Y. Yao, N. M. Bass, B. Nikolai, et al., “Liver Transplantation for Hepatocelluar Carcinoma: Analysis of Survival According to the Intention-to-Treat Principle and Dropout from the Waiting List,” Liver Transplantation, Vol. 8, No. 10, 2002, pp. 873-883.
http://dx.doi.org/10.1053/jlts.2002.34923
[26] I. Yokoyama, B. Carr, H. Saitu, et al., “Accelerated Growth Rate of Recurrent Hepatocellular Carcinoma after Liver Transplantation,” Cancer, Vol. 68, No. 10, 1991, pp. 2095-2100. http://dx.doi.org/10.1002/1097-0142(19911115)68:10<2095::AID-CNCR2820681002>3.0.CO;2-Y
[27] I. Penn, “The Effect of Immunosuppression on Pre-Existing Cancers,” Transplantation, Vol. 55, No. 4, 1993, pp. 742-747.
http://dx.doi.org/10.1097/00007890-199304000-00011
[28] C. E. Freise, L. Ferrell, T. Liu, et al., “Effect of Systemic Cyclosporin on Tumor Recurrence after Liver Transplantation in a Model of Hepatocellular Carcinoma,” Transplantation, Vol. 67, No. 4, 1999, pp. 510-513.
http://dx.doi.org/10.1097/00007890-199902270-00003
[29] V. Marco, B. Roberto, C. Alessandro, et al., “Low Recurrence Rate of Hepatocellular Carcinoma after Liver Transplantation: Better Patient Selection or Lower Immunosuppression?” Transplantation, Vol. 74, No. 12, 2002, pp. 1746-1751.
[30] M. Amer, M. Yousri, F. Barakat, et al., “Pretransplant Chemoembolization for Hepatocellular Carcinoma ≤ cm Does Not Influence the Outcome after Liver Transplantation,” 58th annual meeting of the AASLD, November 2007.

Copyright © 2024 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.