Prognosis analysis of liver transplantation for patients with hepatocellular carcinoma using different criteria

Abstract

Abstract: Objective To compare the prognosis of orthotopic liver transplantation (OLT) under three different criteria in a cohort of cirrhotic patients with hepatocellular carcinoma ( HCC). Methods A total of 391 HCC patients with OLT were enrolled in this retrospective cohort study. They were received OLT under three different criteria, i.e., Milan, “Up-to-seven” and Hangzhou. Cox proportional hazard regression analysis, Kaplan analysis and log-rank test were performed to compare the patients' recurrent rates and outcomes after OLT. P value <0.05 was considered significant. Results Compared to the patients with OLT under Milan criteria, the OLT patients exceeded Milan but within “Up-to-seven” criteria has similar recurrence rate (13.8% vs 21.8%, P=0.17) and disease-free survival (DFS) (10.93±0.3 years vs 9.5±0.7 years, P=0.14), whereas the OLT patients who exceeded “Up-to-seven” but within Hangzhou criteria had significant difference in tumor recurrence (13.8% vs 33.8%, P<0.01), HCC-related death (4.9% vs 23%, P<0.01) and long-term survival (12.2±0.23years vs 9.1±0.79 years, P<0.01). Conclusion The overall survival (OS) and DFS after OLT in HCC patients who exceed Milan but within “Up-to-seven” criteria were excellent,thus they should be offered the option of OLT.

Key words: Liver transplantation, Hepatocellular carcinoma, Milan criteria, Prognosis

ZHANG Da-li, ZHOU Xia, FENG Dan-ni, HE Xi, WANG Hong-bo, GAO Yin-jie, SUN Yan-ling, ZHANG Li-juan, LIU Zhen-wen, LIU Hong-ling. Prognosis analysis of liver transplantation for patients with hepatocellular carcinoma using different criteria[J]. Chinese Hepatolgy, 2020, 25(9): 915-918.

References

[1] Halazun KJ, Najjar M, Abdelmessih RM ,et al. Recurrence after liver transplantation for hepatocellular carcinoma: a new MORAL to the story. Ann Surg, 2017, 265:557-564.
[2] EASL CPG HCC. EASL clinical practice guidelines: management of hepatocellular carcinoma. J Hepatology. 2018, 69:182-236.
[3] Sapisochin G, Bruix J.Liver transplantation for hepatoce-llular carcinoma: outcomes and novel surgical approaches.Nat Rev Gastroenterol Hepatol, 2017,14 :203-217.
[4] Koschny R, Schmidt J, Ganten TM.Beyond Milan criteria--chances and risks of expanding transplantation criteria for HCC patients with liver cirrhosis.Clin Transplant, 23: 49-60.
[5] Zheng SS, Xu X, Wu J, et al. Liver transplantation for hepatocellular carcinoma: Hangzhou experiences. Transplan-tation, 2008, 85:1726-1732.
[6] Vincenzo M, Josep M L, Rosalba M, et al. Predicting survival after liver transplantation in patients with hepatocellular carcinoma beyond the Milan criteria: a retrospective, exploratory analysis. Lancet Oncol, 2009, 10: 35-43.
[7] Anderes FC, Paul M.When to refer for liver transplantation.Am J Gastroenterol, 2019, 114:7-10.
[8] Chan KM, Wu TH, Cheng CH, et al. Advantage of early liver transplantation whenever indicated for hepatocellular carcinoma recurrence after primary liver resection. Biomed J, 2019, 42:335-342.
[9] Nitta H, Allard MA, Sebagh M, et al. Prognostic value and prediction of extratumoral microvascular invasion for hepatocellular carcinoma. Ann Surg Oncol, 2019, 26:2568-2576.
[10] Akinyemiju T, Abera S, Ahmed M, et al.The burden of primary liver cancer and underlying etiologies from 1990 to 2015 at the global, regional, and national level. JAMA Oncol, 2017, 3:1683-1691
[11] Yilmaz C, Karaca C A, Iakobadze Z, et al. Factors affecting recurrence and survival after liver transplantation for hepatocellular carcinoma.Transplant Proc, 2018, 50: 3571-3576
[12] Pérez P, Rodríguez-Perálvarez M, Guerrero L,et al.Incidental hepatocellular carcinoma after liver transplantation: prevalence, histopathological features and prognostic Impact. PLoS One, 2017,12:e0175010
[13] Wallace D, Walker K, Charman S, et al.Assessing the impact of suboptimal donor characteristics on mortality after liver transplantation: a time-dependent analysis comparing HCC with non-HCC patients.Transplantation, 2019, 103: e89-e98.

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