Background. Factors affecting outcomes after orthotopic liver transplantation (OLT) for hepatocellular carcinoma (HCC) have been extensively studied, but some of them have only recently been discovered or reassessed. Methods. We analyzed classical and more recently emerging variables with a hypothetical impact on recurrence-free survival (RFS) in a single-center series of 283 patients transplanted for HCC between 1997 and 2009. Results. Five-year patient survival and RFS were 75% and 86%, respectively. Thirty-four (12%) patients had HCC recurrence. Elevated preoperative alpha-fetoprotein (AFP) levels, preoperative treatments of HCC, unfulfilled Milan and up-to-seven criteria at final histology, poor tumor differentiation, and tumor microvascular invasion negatively affected RFS by univariate analysis. Milan and up-to-seven criteria applied preoperatively, and the use of m-TOR inhibitors did not reach statistical significance. Cox's proportional hazard model showed that only elevated AFP levels (Odds Ratio = 2.88; 95% C.I. = 1.43-5.80; P = .003), preoperative tumor treatments (Odds Ratio = 4.84; 95% C.I. = 1.42-16.42; P = .01), and microvascular invasion (Odds Ratio = 4.82; 95% C.I. = 1.87-12.41; P = .001) were predictors of lower RFS. Conclusions. Biological aggressiveness and preoperative tumor treatment, rather than traditional and expanded dimensional criteria, conditioned the outcomes in patients transplanted for HCC.

Prognostic factors for tumor recurrence after a 12-year, single-center experience of liver transplantations in patients with hepatocellular carcinoma.

CESCON, MATTEO;Matteo Ravaioli;GRAZI, GIAN LUCA;ERCOLANI, GIORGIO;CUCCHETTI, ALESSANDRO;Valentina Bertuzzo;Gaetano Vetrone;Massimo Del Gaudio;VIVARELLI, MARCO;D'ERRICO, ANTONIETTA;Alessandro Dazzi;Paolo Di Gioia;PINNA, ANTONIO DANIELE
2010

Abstract

Background. Factors affecting outcomes after orthotopic liver transplantation (OLT) for hepatocellular carcinoma (HCC) have been extensively studied, but some of them have only recently been discovered or reassessed. Methods. We analyzed classical and more recently emerging variables with a hypothetical impact on recurrence-free survival (RFS) in a single-center series of 283 patients transplanted for HCC between 1997 and 2009. Results. Five-year patient survival and RFS were 75% and 86%, respectively. Thirty-four (12%) patients had HCC recurrence. Elevated preoperative alpha-fetoprotein (AFP) levels, preoperative treatments of HCC, unfulfilled Milan and up-to-seven criteria at final histology, poor tumor differentiation, and tumor microvascular invasion negatively affected RFS by univariate analysis. Milan and up-to-seven criteria applied preoperatively, and the use of m-TOR inhibitors did not reach statistical significance. Cox's proportional hazard model showed that only elevated AFP levels (Odds Ratio = 2.88; 95% C.I. = 1.43-5.80; P = .003), preoperative tumor treatments (Odds Ratio = 4.84; 95% C.I. = 1.42-16.42; P = .01), and microvascular invasion (Odds Ratio = 4.82; 95% C.I. = 1.87-12.41; P = .001) were predictors of lower RFS. Conclusions. Biological aggressiveness and preoperative tumor treatment, rather than traditional and expanded dimensional criteria, conditioned the outcomes in patients transplanted for HCC.
Matteo Cescon; Matteo Ravaioli; Gian Luca Grazi; Giorgio Ercolani; Alessandro Cucchetti; Valentina Bertuzzo; Gaetano Vetrone; Massimo Del Gaudio; Marco Vivarelli; Antonietta D'Errico-Grigioni; Alessandro Dazzi; Paolo Di Gioia; Augusto Lauro; Antonio Daniele Pinna
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/11585/92894
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