Hepatocellular carcinoma developed on compensated cirrhosis: Resection as a selection tool for liver transplantation

Authors

  • Olivier Scatton,

    1. Department of Hepatobiliary Surgery and Liver Transplantation, Hôpital Cochin, Université Paris Descartes, 27 Rue du Faubourg Saint Jacques, 75014 Paris, France
    2. Department of Assistance Publique–Hôpitaux de Paris, Hôpital Cochin, Université Paris Descartes, 27 Rue du Faubourg Saint Jacques, 75014 Paris, France
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  • Stéphane Zalinski,

    1. Department of Hepatobiliary Surgery and Liver Transplantation, Hôpital Cochin, Université Paris Descartes, 27 Rue du Faubourg Saint Jacques, 75014 Paris, France
    2. Department of Assistance Publique–Hôpitaux de Paris, Hôpital Cochin, Université Paris Descartes, 27 Rue du Faubourg Saint Jacques, 75014 Paris, France
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  • Benoit Terris,

    1. Department of Pathology, Hôpital Cochin, Université Paris Descartes, 27 Rue du Faubourg Saint Jacques, 75014 Paris, France
    2. Department of Assistance Publique–Hôpitaux de Paris, Hôpital Cochin, Université Paris Descartes, 27 Rue du Faubourg Saint Jacques, 75014 Paris, France
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  • Jérémie H. Lefevre,

    1. Department of Hepatobiliary Surgery and Liver Transplantation, Hôpital Cochin, Université Paris Descartes, 27 Rue du Faubourg Saint Jacques, 75014 Paris, France
    2. Department of Assistance Publique–Hôpitaux de Paris, Hôpital Cochin, Université Paris Descartes, 27 Rue du Faubourg Saint Jacques, 75014 Paris, France
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  • Alessandra Casali,

    1. Department of Hepatobiliary Surgery and Liver Transplantation, Hôpital Cochin, Université Paris Descartes, 27 Rue du Faubourg Saint Jacques, 75014 Paris, France
    2. Department of Assistance Publique–Hôpitaux de Paris, Hôpital Cochin, Université Paris Descartes, 27 Rue du Faubourg Saint Jacques, 75014 Paris, France
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  • Pierre-Philippe Massault,

    1. Department of Hepatobiliary Surgery and Liver Transplantation, Hôpital Cochin, Université Paris Descartes, 27 Rue du Faubourg Saint Jacques, 75014 Paris, France
    2. Department of Assistance Publique–Hôpitaux de Paris, Hôpital Cochin, Université Paris Descartes, 27 Rue du Faubourg Saint Jacques, 75014 Paris, France
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  • Filomena Conti,

    1. Department of Hepatobiliary Surgery and Liver Transplantation, Hôpital Cochin, Université Paris Descartes, 27 Rue du Faubourg Saint Jacques, 75014 Paris, France
    2. Department of Assistance Publique–Hôpitaux de Paris, Hôpital Cochin, Université Paris Descartes, 27 Rue du Faubourg Saint Jacques, 75014 Paris, France
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  • Yvon Calmus,

    1. Department of Hepatobiliary Surgery and Liver Transplantation, Hôpital Cochin, Université Paris Descartes, 27 Rue du Faubourg Saint Jacques, 75014 Paris, France
    2. Department of Assistance Publique–Hôpitaux de Paris, Hôpital Cochin, Université Paris Descartes, 27 Rue du Faubourg Saint Jacques, 75014 Paris, France
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  • Olivier Soubrane

    Corresponding author
    1. Department of Hepatobiliary Surgery and Liver Transplantation, Hôpital Cochin, Université Paris Descartes, 27 Rue du Faubourg Saint Jacques, 75014 Paris, France
    2. Department of Assistance Publique–Hôpitaux de Paris, Hôpital Cochin, Université Paris Descartes, 27 Rue du Faubourg Saint Jacques, 75014 Paris, France
    • Hôpital Cochin, Université Paris V, 27 Rue du Faubourg Saint Jacques, 75014 Paris, France
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    • Telephone: 33158411734; FAX: 33158411743


Abstract

The objective of this study was to evaluate the histological profile obtained from primary resection of hepatocellular carcinoma (HCC) as a selection tool for liver transplantation (LT). The natural history of HCC depends on its histological features. The clinical effectiveness of resection as a selection tool for salvage or de principe LT has been previously advocated. Between 1987 and 2006, 20 patients underwent a resection prior to LT. Long-term survival of these 20 patients was compared to that of 73 patients who underwent primary LT. Histological features of the resected specimen were compared to those of the recurrences. Feasibility, morbidity, and mortality of LT following primary resection were also analyzed. Mean follow-up was 3.8 ± 4.4 and 2.7 ± 4.5 years from resection and LT, respectively; 6 patients died. The mean 1-, 3-, 5-, and 10-year overall survival rates were 71%, 61%, 55%, and 45% and 74%, 66%, 66%, and 40% after primary transplantation and primary resection, respectively (not significant). At LT, 14 patients had a recurrence, but histological study of the recurrence was not possible in 2 (complete necrosis). For 9 patients (75%), histological features of both primary and recurrent tumors were exactly the same. Four patients had recurrence following LT; in each case, primary and recurrent nodules shared the same histological markers of poor prognosis. De principe transplantation was proposed to 6 patients because of poor prognosis histological features on the resected specimen. All these patients are alive without recurrence with a mean follow-up of 55 months. In conclusion, the natural history of HCC can be predicted on the basis of the histological profile of the resected specimen, which may be used as a selection tool for LT. De principe LT in patients within Milan criteria with poor prognosis histological features may be an optimal strategy. Liver Transpl 14:779–788, 2008. © 2008 AASLD.

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