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 24 May 2018

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News

Differentiation grade predicts liver transplant survival

Histological grade of differentiation and macroscopic vascular invasion are strong predictors of survival in patients with cirrhosis who received transplants for hepatocellular carcinoma, finds December's American Journal of Gastroenterology.

News image

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Dr Claudio Zavaglia and colleagues from Italy identified predictors of survival and tumor-free survival with orthotopic liver transplantation.

The research team assessed of a cohort of 155 patients, with hepatocellular carcinoma and cirrhosis, who were treated by orthotopic liver transplantation.

The team reported 603 orthotopic liver transplantations were performed in 549 patients from 1989 to 2002.

Hepatocellular carcinoma was diagnosed in 116 patients before orthotopic liver transplantation and in 39 at histological examination of the explanted livers.

The team reported that 84% of the patients met 'Milan' criteria at histology, and 94 patients received anticancer therapies preoperatively.

The median follow-up was 49 months.

Overall, 1-, 3-, 5-, and 10-yr survival were 84%, 75%, 72%, and 62%, respectively.

The researchers found that survival was not affected by the patient's age or sex, or etiology of liver disease.

5-year patient survival with poorly differentiated hepatocellular carcinoma was 44%
American Journal of Gastroenterology

Child score at transplantation, rejection episodes, tumor number, total tumor burden, or bilobar tumor did also not affect survival.

In addition, the team observed that survival was not affected by pathologic Tumor, Nodes, Metastasis stages.

There was no significant difference in survival when patients were grouped according to the recently proposed simplified Tumor, Nodes, Metastasis staging.

The team noted no difference in survival with grouping patients according to the United Network for Organ Sharing staging system for hepatocellular carcinoma.

The researchers observed that encapsulation of the tumor and α-fetoprotein levels significantly affected patient survival.

The 5-year patient survival with poorly differentiated hepatocellular carcinoma was 44%.

The team found that patients with moderately or well-differentiated hepatocellular carcinoma had 5-year survival rates of 67% and 97%, respectively.

The 5-year survival of patients with micro- or macro-vascular invasion was 49% vs 77% for patients without vascular invasion.

Multivariate analysis showed that histological grade of differentiation and macroscopic vascular invasion are independent predictors of survival.”

Dr Zavaglia's team commented, “Histological grade of differentiation and macroscopic vascular invasion, as assessed on the explanted livers, are strong predictors of both survival and tumor recurrence in patients with cirrhosis who received transplants for hepatocellular carcinoma.”

Am J Gastroenterol 2005: 100(12): 2708
19 December 2005

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