Vascular invasion and histopathologic grading determine outcome after liver transplantation for hepatocellular carcinoma in cirrhosis

Authors

  • Sven Jonas,

    1. Departments of General, Visceral, and Transplantation Surgery, Charité-Campus Virchow Klinikum, Humboldt University, Berlin, Germany
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  • Wolf O. Bechstein,

    1. Departments of General, Visceral, and Transplantation Surgery, Charité-Campus Virchow Klinikum, Humboldt University, Berlin, Germany
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  • Thomas Steinmüller,

    1. Departments of General, Visceral, and Transplantation Surgery, Charité-Campus Virchow Klinikum, Humboldt University, Berlin, Germany
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  • Martin Herrmann,

    1. Departments of General, Visceral, and Transplantation Surgery, Charité-Campus Virchow Klinikum, Humboldt University, Berlin, Germany
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  • Cornelia Radke,

    1. Institute of Pathology, Charité-Campus Virchow Klinikum, Humboldt University, Berlin, Germany
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  • Thomas Berg,

    1. Departments of Gastroenterology and Hepatology, Charité-Campus Virchow Klinikum, Humboldt University, Berlin, Germany
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  • Utz Settmacher,

    1. Departments of General, Visceral, and Transplantation Surgery, Charité-Campus Virchow Klinikum, Humboldt University, Berlin, Germany
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  • Peter Neuhaus

    Corresponding author
    1. Departments of General, Visceral, and Transplantation Surgery, Charité-Campus Virchow Klinikum, Humboldt University, Berlin, Germany
    • Dept. of General, Visceral, and Transplantation Surgery, Charité-Campus Virchow Klinikum, Humboldt University Berlin, Augustenburger Platz 1, D-13353 Berlin, Germany. Fax: (49) 30-450-552900.
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Abstract

Selection of patients suffering from hepatocellular carcinoma (HCC) in cirrhosis for liver transplantation follows limits of number and diameter of tumor nodules. It has not been investigated whether there is a correlation of these parameters with vascular invasion. From 1989 to 2000, 1,188 liver transplantations were performed in 1,087 patients, including 120 patients (11%) with an HCC in cirrhosis. Selection criteria were a maximal diameter of up to 5 cm if the tumor appeared to be uninodular or of up to 3 cm in the case of 2 or 3 nodules. The postoperative mortality rate was 1.7%. One-, 5-, and 10-year survival was 90%, 71%, and 60%, respectively. In 940 transplantation patients without an HCC, these rates were 93%, 87%, and 83% (P < .0001). Vascular invasion and histopathologic grading were identified as prognostic parameters by multivariate analysis. In a logistic regression analysis, histopathologic grading and maximal diameter showed a significant correlation with a vascular invasion. Analyzing tumors larger than 5 cm, i.e., tumors not fulfilling the selection criteria as a result of diagnostic inaccuracy or progression thereafter, the rates of vascular invasion were significantly (P < .01) lower in patients suffering from well-differentiated tumors (25%) when compared with moderately and poorly differentiated tumors (100%). Liver transplantation is a safe and effective long-term treatment for small HCC in cirrhosis. Tumor diameter and number of nodules in correlation with the histopathologic grading were predictive of a vascular invasion only in HCC larger than 5 cm.

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