Liver transplantation for hepatocellular carcinoma: prognostic analysis of 89 cases / 中华外科杂志

ABSTRACT

<p><b>OBJECTIVE</b>To summarize the experience of liver transplantation (LT) for hepatocellular carcinoma (HCC) in one center and identify prognostic factors for survival.</p><p><b>METHODS</b>The clinical data and survival results of 89 patients with HCC receiving LT from January 1999 to December 2003 were retrospectively analyzed and various clinicopathologic risk factors for actuarial survival and tumor free survival were evaluated by univariate and multivariate analysis.</p><p><b>RESULTS</b>Six-month, 1-, and 2-year survival rates were 81.8%, 55.3% and 43.7%, respectively. The 6-month, 1-, and 2-year tumor free survival rates were 62.4%, 35.6% and 24.9%, respectively. The overall tumor recurrence and metastasis rate was 52.8%. In the univariate analysis, portal vein tumor thrombi (PVTT) (chi(2) = 15.14, P = 0.0001), tumor size (chi(2) = 15.05, P = 0.0001), hepatic cirrhosis background (chi(2) = 6.14, P = 0.0132), preoperative alpha-fetoprotein (AFP) level (chi(2) = 5.82, P = 0.0159) and histopathologic grading (chi(2) = 4.61, P = 0.0319) were found to be significantly associated with actuarial survival rate. Seven factors influencing tumor free survival included PVTT (chi(2) = 26.30, P < 0.0001), tumor size (chi(2) = 25.25, P < 0.0001), preoperative AFP level (chi(2) = 14.83, P = 0.0001), histopathologic grading (chi(2) = 12.54, P = 0.0004), tumor distribution (chi(2) = 12.73, P = 0.0004), number of nodules (chi(2) = 9.81, P = 0.0017) and cirrhosis background (chi(2) = 9.76, P = 0.0018). In the multivariate Cox regression analysis, the prognostic factors independently associated with patient survival were identified to be PVTT (RR = 4.721, P = 0.001), age (RR = 3.282, P = 0.007) and histopathologic grading (RR = 2.368, P = 0.037). For tumor free survival, histopathologic grading (RR = 3.739, P < 0.0001), PVTT (RR = 4.382, P = 0.001), cirrhosis background (RR = 0.421, P = 0.011), age (RR = 2.312, P = 0.027) and AFP (RR = 2.301, P = 0.047) were identified as prognostic parameters.</p><p><b>CONCLUSIONS</b>LT is a good therapeutic option for strictly selected patients with HCC. PVTT and histopathologic grading are the most important factors of predicting outcomes of HCC patients undergoing LT. Further studies should be strengthened to establish a reliable and feasible selection criteria and an optimal prognosis scoring system for LT.</p>