Selection of Patients with Solitary Lesion of Hepatocellular Cancer for Liver Transplantation.
1Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
2Department of General, Transplant and Liver Surgery, Liver and Internal Medicine Unit, Medical University of Warsaw, Warsaw, Poland
3Second Department of Clinical Radiology, Medical University of Warsaw, Warsaw, Poland
4Department of Epidemiology, Medical University of Warsaw, Warsaw, Poland.
Meeting: 2016 American Transplant Congress
Abstract number: A192
Keywords: Hepatocellular carcinoma, Liver transplantation, Malignancy, Recurrence
Session Information
Date: Saturday, June 11, 2016
Session Name: Poster Session A: Liver - Hepatocellular Carcinoma and Cholangiocarcinoma Malignancies
Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Halls C&D
Milan criteria are considered as benchmark for selection of patients with hepatocellular cancer (HCC) for liver transplantation. The aim of this study was to evaluate their performance in patients with solitary lesion of HCC and potentially, to find an optimal method of their modification. Out of 1602 liver transplantations performed in our centre between December 1989 and April 2015 (including 240 for HCC), 124 performed for solitary tumors were analyzed retrospectively. Recurrence-free survival (RFS) at 5 years was set as the primary outcome measure. In all patients, 5-year RFS was 89.3%, with the corresponding rates in patients within and beyond Milan criteria of 92.4% and 74.3%, respectively (p=0.076). Analyses of risk factors revealed that only diameter of the largest tumor (p=0.023) and serum alpha-fetoprotein (AFP) concentration (p=0.018) were significantly associated with RFS, with similar predictive features (p=0.539) and optimal cut-offs of 4.3 cm and 70 ng/ml, respectively. Division of patients into low- and high-risk subgroups based on these cut-offs was associated with significant differences in 5-year RFS (96.5% versus 70.9% [p=0.002] for size-based division and 95.1% versus 76.3% [p=0.003] for AFP-based division) Moreover, RFS at 5 years was 100.0% in patients with tumor size <4.3 cm and AFP <70 ng/ml, 88.0% in patients with either tumor size ≥4.3 cm or AFP >70 ng/ml, and 46.9% in patients with both negative features (p<0.001). Notably, only 8.3% (10 of 120) of all patients were in the latter subgroup as compared to 16.1% (20 of 124) of patients exceeding the Milan criteria. In conclusion, combination of tumor size with AFP may be useful both in minimization of the recurrence risk or expansion of Milan criteria without negative effects on long-term outcomes in patients with solitary lesion of HCC undergoing liver transplantation.
CITATION INFORMATION: Grąt M, Stypułkowski J, Patkowski W, Wronka K, Wasilewicz M, Grąt K, Masior L, Krasnodębski M, Lewandowski Z, Krawczyk M. Selection of Patients with Solitary Lesion of Hepatocellular Cancer for Liver Transplantation. Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:
Grąt M, Stypułkowski J, Patkowski W, Wronka K, Wasilewicz M, Grąt K, Masior L, Krasnodębski M, Lewandowski Z, Krawczyk M. Selection of Patients with Solitary Lesion of Hepatocellular Cancer for Liver Transplantation. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/selection-of-patients-with-solitary-lesion-of-hepatocellular-cancer-for-liver-transplantation/. Accessed March 3, 2021.« Back to 2016 American Transplant Congress