BACKGROUND & AIMS: The role of liver transplantation in the treatment of hepatocellular carcinoma in livers without fibrosis/cirrhosis (NC-HCC) is unclear. We aimed to determine selection criteria for liver transplantation in patients with NC-HCC. METHODS: Using the European Liver Transplant Registry, we identified 105 patients who underwent liver transplantation for unresectable NC-HCC. Detailed information about patient, tumor characteristics, and survival was obtained from the transplant centers. Variables associated with survival were identified using univariate and multivariate statistical analyses. RESULTS: Liver transplantation was primary treatment in 62 patients and rescue therapy for intrahepatic recurrences after liver resection in 43. Median number of tumors was 3 (range 1-7) and median tumor size 8cm (range 0.5-30). One- and 5-year overall and tumor-free survival rates were 84% and 49% and 76% and 43%, respectively. Macrovascular invasion (HR 2.55, 95% CI 1.34 to 4.86), lymph node involvement (HR 2.60, 95% CI 1.28 to 5.28), and time interval between liver resection and transplantation <12months (HR 2.12, 95% CI 0.96 to 4.67) were independently associated with survival. Five-year survival in patients without macrovascular invasion or lymph node involvement was 59% (95% CI 47-70%). Tumor size was not associated with survival. CONCLUSIONS: This is the largest reported series of patients transplanted for NC-HCC. Selection of patients without macrovascular invasion or lymph node involvement, or patients ⩾12months after previous liver resection, can result in 5-year survival rates of 59%. In contrast to HCC in cirrhosis, tumor size is not a predictor of post-transplant survival in NC-HCC.
|Autori:||Mergental H; Adam R; Ericzon BG; Kalicinski P; Mühlbacher F; Höckerstedt K; Klempnauer JL; Friman S; Broelsch CE; Mantion G; Fernandez-Sellez C; van Hoek B; Fangmann J; Pirenne J; Muiesan P; Königsrainer A; Mirza DF; Lerut J; Detry O; Le Treut YP; Mazzaferro V; Löhe F; Berenguer M; Clavien PA; Rogiers X; Belghiti J; Kóbori L; Burra P; Wolf P; Schareck W; Pisarski P; Foss A; Filipponi F; Krawczyk M; Wolff M; Langrehr JM; Rolles K; Jamieson N; Hop WC; Porte RJ.|
|Titolo:||Liver transplantation for unresectable hepatocellular carcinoma in normal livers.|
|Anno del prodotto:||2012|
|Appare nelle tipologie:||1.1 Articolo in rivista|