Analysis of longer term survival following liver transplantation for hepatocellular carcinoma (HCC-LT) has been limited to single center series or registry analyses lacking pathologic detail.
A novel NCI-funded database linking clinical (pre-LT) and pathological analysis of liver explants with OPTN registry for 2980 HCC-LT recipients transplanted using standard HCC exceptions between 2002 and 2006 was analyzed to assess overall and HCC-recurrence free survival. Patients were categorized using ALTSG staging for HCC 1, 2 [Milan Criteria (MC)] or > 2. Stratified Kaplan-Meier and adjusted Cox and logistic regression models were used to predict outcomes.
The majority of HCC-LT patients had hepatitis C (55.7%) or B (9.7%) virus. At time of listing, 85% of HCC-LT patients were within MC, and 74% met MC on liver explant pathology. The mean biologic MELD score at transplant was 12.7. Most HCC-LT recipients received standard criteria donors (72.5%); however, 44% were from donors aged > 60. Among 2801 HCC-LT patients with valid recurrence reports, HCC recurrence was detected in 209.
Five-year post-LT survival declined with more advanced pre-LT HCC stage (P=0.009). Pre-LT stage, recipient age > 46, black race, donor age >60 and donor diabetes were strongly associated with poorer survival. Similarly, explant pathology predicted the risk of post-LT death. Compared to HCC-LT patients without an active tumor (stage 0), pathologic stage 3 disease increased risk of death by 70%, path stage 4a by 100%, and 4b by > 300%. Odds of HCC recurrence followed a similar pattern. Patients with macrovascular invasion (stage 4b) had a 12 fold increase of recurrence compared to patients with no evidence of cancer on pathology reports.
Patients beyond stage 2 disease radiologicaly or pathologically had substantially greater risk of death and recurrence. Current restriction of LT to HCC patients with stage 2 disease appears reasonable given these findings.
To cite this abstract in AMA style:Stark C, Dzebisashvili N, Mezochow G, Harper A, Edwards E, Axelrod D, Freeman R. Predicting Survival and Recurrence Following Liver Transplantation for Hepatocellular Carcinoma: National Analysis of Clinical and Pathologic Staging [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/predicting-survival-and-recurrence-following-liver-transplantation-for-hepatocellular-carcinoma-national-analysis-of-clinical-and-pathologic-staging/. Accessed October 27, 2020.
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