TITLE:
Do Tumor Characteristics and Pre-Transplant Locoregional Therapy Predict Survival after OLT in Patients with Hepatocellular Carcinoma?
AUTHORS:
Mohamed Kohla, Richard Shaw, Garret Hisatak, Robert Osorio, Maurizio Bonacini
KEYWORDS:
Tumor Characteristics; Locoregional Therapy; Hepatolcellular Carcinoma; Liver Transplantation; OLT; Survival
JOURNAL NAME:
International Journal of Clinical Medicine,
Vol.4 No.12A,
December
30,
2013
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