Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
, 6 (3), 646-656
eCollection

Survival Advantage of Primary Liver Transplantation for Hepatocellular Carcinoma Within the up-to-7 Criteria With Microvascular Invasion

Affiliations

Survival Advantage of Primary Liver Transplantation for Hepatocellular Carcinoma Within the up-to-7 Criteria With Microvascular Invasion

See Ching Chan et al. Hepatol Int.

Abstract

Purpose: Microvascular invasion of hepatocellular carcinoma (HCC) is considered a poor prognostic factor of liver resection (LR) and liver transplantation (LT), but its significance for lesions within the up-to-7 criteria is unclear. This study investigated the survival benefit of primary LT against LR for HCC with microvascular invasion and within the up-to-7 criteria.

Methods: Adult patients who underwent LR or LT as the primary treatment for HCC were included for study. Patients with prior local ablation, neoadjuvant systemic chemotherapy, targeted therapy, positive resection margin, or metastatic spread were excluded.

Results: There were 471 LR patients and 95 LT recipients (70 with living donor, 25 with deceased donor). Seventy-seven (81.1%) LT recipients had HCC within the up-to-7 criteria. Twenty-five (26.3%) LT recipients had HCC with either macrovascular (n = 4) or microvascular (n = 21) invasion. The 5-year survival rate was 85.7% for LT recipients with HCC within the up-to-7 criteria, unaffected by the presence or absence of vascular invasion (88.2 vs. 85.1%). The rate was comparable with that of LR patients with HCC without vascular invasion (81.2%, p 0.227), but far superior to that of LR patients with lesions with vascular invasion (50.0%, p < 0.0001). Overall survivals were compromised by multiple tumors [odds ratio (OR) 1.902, confidence interval (CI) 1.374-2.633, p = 0.0001], vascular invasion (OR 2.678, CI 1.952-3.674, p < 0.0001), blood transfusion (OR 2.046, CI 1.337-3.131, p = 0.001), and being beyond the up-to-7 criteria (OR 1.457, CI 1.041-2.037, p = 0.028). LT was a favorable factor for survival (OR 0.243, CI 0.130-0.454, p < 0.0001).

Conclusion: Primary LT for HCC with microvascular invasion and within the up-to-7 criteria doubled the chance of cure as compared with LR.

Keywords: Hepatocellular carcinoma; Liver transplantation; Microvascular invasion; Survival.

Figures

Fig. 1
Fig. 1
Overall survival of patients who underwent LT or LR for HCC
Fig. 2
Fig. 2
Disease-free survival of patients who underwent LT or LR for HCC
Fig. 3
Fig. 3
Overall survival of patients within the up-to-7 criteria who underwent LT or LR for HCC
Fig. 4
Fig. 4
Disease-free survival of patients within the up-to-7 criteria who underwent LT or LR for HCC
Fig. 5
Fig. 5
The courses of disease of recipients with recurrence of HCC after LT
Fig. 6
Fig. 6
Overall survival of patients who underwent LT or LR according to various stages of the up-to-7 criteria
Fig. 7
Fig. 7
Overall survival of patients who underwent LT or LR according to various stages of the up-to-7 criteria in relation to presence or absence of vascular invasion
Fig. 8
Fig. 8
Overall survival of patients who underwent LT or LR according to various stages of the up-to-7 criteria in relation to presence or absence of vascular invasion

Similar articles

See all similar articles

Cited by 17 PubMed Central articles

See all "Cited by" articles

References

    1. Vauthey JN, Lauwers GY, Esnaola NF, et al. Simplified staging for hepatocellular carcinoma. J Clin Oncol. 2002;20:1527–1536. doi: 10.1200/JCO.20.6.1527. - DOI - PubMed
    1. Cho YB, Lee KU, Lee HW, et al. Outcomes of hepatic resection for a single large hepatocellular carcinoma. World J Surg. 2007;31:795–801. doi: 10.1007/s00268-006-0359-z. - DOI - PubMed
    1. Duffy JP, Vardanian A, Benjamin E, et al. Liver transplantation criteria for hepatocellular carcinoma should be expanded: a 22-year experience with 467 patients at UCLA. Ann Surg. 2007;246:502–509. doi: 10.1097/SLA.0b013e318148c704. - DOI - PMC - PubMed
    1. Mazzaferro V, Llovet JM, Miceli R, et al. Predicting survival after liver transplantation in patients with hepatocellular carcinoma beyond the Milan criteria: a retrospective, exploratory analysis. Lancet Oncol. 2009;10:35–43. doi: 10.1016/S1470-2045(08)70284-5. - DOI - PubMed
    1. D’Amico G, Garcia-Tsao G, Pagliaro L. Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies. J Hepatol. 2006;44:217–231. doi: 10.1016/j.jhep.2005.10.013. - DOI - PubMed

LinkOut - more resources

Feedback