J Pathol Transl Med.  2017 Jan;51(1):79-86. 10.4132/jptm.2016.10.13.

Prognosis of Hepatocellular Carcinoma after Liver Transplantation: Comparative Analysis with Partial Hepatectomy

• Lee K
• Lee KB
• Yi NJ
• Suh KS
• Jang JJ

• KMID: 2367683
• DOI: http://doi.org/10.4132/jptm.2016.10.13

Abstract

BACKGROUND
Liver transplantation (LT) is the treatment of choice for hepatocellular carcinoma (HCC). The aim of this study was to investigate the recurrence rate of HCC after LT and prognostic factors for recurrence by comparing LT with non-transplanted resection.
METHODS
The participants were 338 patients who underwent LT between 1996 and 2012 at Seoul National University Hospital (LT group) and 520 HCC patients who underwent partial hepatectomy between 1995 and 2006 (control group, non-LT group).
RESULTS
In the LT group, 68 of 338 patients (19.8%) showed relapse, and the recurrence rate was lower than that in the non-LT group (64.9%, 357/520, p < .001). Stratification analysis by American Joint Committee on Cancer (AJCC) stage showed that the stage I-II LT group had a lower recurrence rate than the non-LT group. Univariate comparative analysis demonstrated that multiplicity of tumor, tumor size, gross type, Edmondson- Steiner (ES) nuclear grade, extent of tumor, angioinvasion, AJCC stage, Milan criteria, University of California at San Francisco criteria on explant pathology (all p < .001), positive expression of cytokeratin 19 (p = .002), and preoperative α-fetoprotein (AFP) (p < .001) were predictors of tumor recurrence. In multivariate analysis, LT, preoperative AFP, multiplicity of tumor, extent of tumor, size of tumor, and ES nuclear grade were independent prognostic factors.
CONCLUSIONS
LT might have a protective effect against the late recurrence of stage I-II HCC compared to non-LT, and the prognostic factors for recurrence were similar to previously well-known prognostic factors for HCC.

Keyword

Liver transplantation; Hepatocellular carcinoma; Recurrence; Prognosis

MeSH Terms

California
Carcinoma, Hepatocellular*
Hepatectomy*
Humans
Joints
Keratin-19
Liver Transplantation*
Liver*
Multivariate Analysis
Pathology
Prognosis*
Recurrence
Seoul
Keratin-19

Figure

• 

  Fig. 1. Comparison of prognostic factors between the liver transplantation (LT) group and the non-LT group by univariate disease-free survival analysis. HRs of LT and non-LT groups calculated by Cox proportional hazard model are plotted in each row. HR (95% CI), hazard ratio (95% confidence interval) by Cox proportional hazard model; LT, liver transplantation; ES nuclear grade, Edmonson Steiner nuclear grade; CLD, chronic liver disease; AFP, α-fetoprotein; AJCC, American Joint Committee on Cancer; UCSF, University of California at San Francisco criteria. aParameters are statistically significant prognostic factors (log-rank p<.05).

• 

  Fig. 2. Kaplan-Meier curves for disease-free survival (DFS) between the liver transplantation (LT) group and the non-LT group. (A) The DFS of patients with any stage disease was significantly longer in the LT group than in the non-LT group (p<.001). (B) Among patients with stage I-II disease, DFS was also longer in the LT group than in the non-LT group (p<.001). (C) There were no significant differences in the DFS of stage III–IV patients between the LT and non-LT groups. AJCC, American Joint Committee on Cancer.

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