Liver transplantation for hepatocellular carcinoma: Expansion of the tumor size limits does not adversely impact survival

Authors

  • Francis Y. Yao M.D.,

    Corresponding author
    1. Medicine, University of California, San Francisco, San Francisco, CA
    2. Liver Center, University of California, San Francisco, San Francisco, CA
    • Division of Gastroenterology, Department of Medicine, University of California, San Francisco, Box 0538, 513 Parnassus Avenue, Room S-357, San Francisco, CA 94143-0538. fax: 415-476-0659.
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  • Linda Ferrell,

    1. Pathology, University of California, San Francisco, San Francisco, CA
    2. Liver Center, University of California, San Francisco, San Francisco, CA
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  • Nathan M. Bass,

    1. Medicine, University of California, San Francisco, San Francisco, CA
    2. Liver Center, University of California, San Francisco, San Francisco, CA
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  • Jessica J. Watson,

    1. Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA
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  • Peter Bacchetti,

    1. Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA
    2. Liver Center, University of California, San Francisco, San Francisco, CA
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  • Alan Venook,

    1. Medicine, University of California, San Francisco, San Francisco, CA
    2. Liver Center, University of California, San Francisco, San Francisco, CA
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  • Nancy L. Ascher,

    1. Surgery, University of California, San Francisco, San Francisco, CA
    2. Liver Center, University of California, San Francisco, San Francisco, CA
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  • John P. Roberts

    1. Surgery, University of California, San Francisco, San Francisco, CA
    2. Liver Center, University of California, San Francisco, San Francisco, CA
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Abstract

The precise staging of hepatocellular carcinoma (HCC) based on the size and number of lesions that predict recurrence after orthotopic liver transplantation (OLT) has not been clearly established. We therefore analyzed the outcome of 70 consecutive patients with cirrhosis and HCC who underwent OLT over a 12-year period at our institution. Pathologic tumor staging of the explanted liver was based on the American Tumor Study Group modified Tumor-Node-Metastases (TNM) Staging Classification. Tumor recurrence occurred in 11.4% of patients after OLT. The Kaplan-Meier survival rates at 1 and 5 years were 91.3% and 72.4%, respectively, for patients with pT1 or pT2 HCC; and 82.4% and 74.1%, respectively, for pT3 tumors (P = .87). Patients with pT4 tumors, however, had a significantly worse 1-year survival of 33.3% (P = .0001). An α-fetoprotein (AFP) level > 1,000 ng/mL, total tumor diameter > 8 cm, age ≥ 55 years and poorly differentiated histologic grade were also significant predictors for reduced survival in univariate analysis. Only pT4 stage and total tumor diameter remained statistically significant in multivariate analysis. Patients with HCC meeting the following criteria: solitary tumor ≤ 6.5 cm, or ≤ 3 nodules with the largest lesion ≤ 4.5 cm and total tumor diameter ≤ 8 cm, had survival rates of 90% and 75.2%, at 1 and 5 years, respectively, after OLT versus a 50% 1-year survival for patients with tumors exceeding these limits (P = .0005). We conclude that the current criteria for OLT based on tumor size may be modestly expanded while still preserving excellent survival after OLT.

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