The team undertook a large multicenter study to assess survival and related factors of recurrence after orthotopic liver transplantation (OLT) in patients with hepatocellular carcinoma (HCC) and cirrhosis.
The findings of the study were published in the October issue of Liver Transplantation.
OLT offers the only chance to eliminate both tumor and liver disease in patients with HCC and cirrhosis. However, tumor progression while on the waiting list, and recurrence after OLT are frequent.
Data from 307 consecutive patients with HCC and cirrhosis treated with OLT was analyzed. All operations were carried out between 1990 and 1997 in 8 centers in Spain
OLT was indicated only for small (<5 cm) localized tumors.
|Selection criteria for OLT:|
- Small HCCs
- Low alpha fetoprotein levels
- No macroscopic vascular invasion
| Liver Transplantation |
Five-year rates after OLT were 63% for survival, 58% for disease-free survival, and 21% for recurrence.
Tumor diameter larger than 5 cm was associated with other tumor characteristics that were significant indicators of poor outcome (absence of capsule, 3 or more nodules, bilobularity, satellite nodules, and vascular invasion).
However, in multivariate analysis, alpha fetoprotein levels greater than 300 ng/mL and macroscopic vascular invasion were the only factors independently associated with mortality and recurrence, respectively.
Author Juan Figueras, of the Hospital de Bellvitge, Barcelona, said on behalf of the group, "OLT is indicated in patients with small HCCs who have low alpha fetoprotein levels and no macroscopic vascular invasion or extrahepatic disease."
"By increasing our ability for preoperative tumor imaging, we will achieve better selection of patients with HCC before OLT," it was concluded.