Original Article on Liver Transplantation for Hepatocellular Carcinoma
Liver transplantation for small hepatocellular carcinoma
Abstract
Background: We treat small hepatocellular carcinoma (HCC) ≤3 cm in diameter by liver transplantation (LT) considering liver reserve and HCC localization, and when other treatment would be ineffective. However, the outcomes of LT and the clinicopathological features of small HCC ≤3 cm in diameter are not clear. We analyzed the outcomes of LT for small HCC ≤3 cm in diameter.
Methods: Between February 1999 and August 2015, 223 patients underwent LT for HCC at Kyoto University Hospital. We analyzed the proportion of small HCC ≤3 cm in diameter (small HCC) among all patients, the background of small HCC, survival and recurrence rates within and beyond the Milan criteria (MC), Kyoto criteria (KC) [≤5 cm, N ≤10, des-gamma-carboxy prothrombin (DCP) ≤400], and rates of survival and recurrence after LT with or without pretreatment.
Results: Among the 223 patients, 159 (71%) had small HCC accompanied by hepatitis B virus (HBV), 43 (27%); hepatitis C virus (HCV), 96 (61%); HBV, HCV, 5 (3%) and non B non C, 15 (9%). One hundred and fourteen (72%) patients were male with a tumor radius of 2 (range, 0.4–3) cm; number of tumors, 2 (range, 1–186); alpha-fetoprotein (AFP) 28.5 (range, 1.3–12,727) and DCP 42 (range, 5–20,600). The tumors were well, moderately and poorly differentiated in 22 (14%), 105 (66%) and 24 (15%) patients, respectively. Among the patients, 124 (78%) and 132 (83%) were within the MC and KC, respectively. One-, three- and five-year survival rates associated with tumors within and beyond the MC were 87%, 81% and 79% vs. 94%, 76%, and 70%, respectively (P=0.430) and recurrence rates were significantly lower in patients within MC than in patients beyond MC (P<0.001). One-, three- and five-year survival rates associated with tumors within and beyond KC were 89%, 85%, and 83% vs. 89%, 58%, and 50%, respectively (P<0.001) and recurrence rates were 2%, 3%, and 4% vs. 21%, 37%, and 47%, respectively (P<0.001). Survival and recurrence rates were significantly higher and lower, respectively, among patients whose tumors were within, than beyond the KC. The one, three and five-year survival rates of patients with or without pretreatment were 89%, 79%, and 75% vs. 86%, 81%, and 81%, respectively (P=0.315) and recurrence rates were 6%, 10%, and 15% vs. 2%, 2%, and 2%, respectively (P=0.040). Recurrence rates were significantly higher in patients with pretreatment than in those without pretreatment.
Conclusions: Outcomes after LT were favorable for patients with small HCC that meet MC criteria or are less biologically malignant.
Methods: Between February 1999 and August 2015, 223 patients underwent LT for HCC at Kyoto University Hospital. We analyzed the proportion of small HCC ≤3 cm in diameter (small HCC) among all patients, the background of small HCC, survival and recurrence rates within and beyond the Milan criteria (MC), Kyoto criteria (KC) [≤5 cm, N ≤10, des-gamma-carboxy prothrombin (DCP) ≤400], and rates of survival and recurrence after LT with or without pretreatment.
Results: Among the 223 patients, 159 (71%) had small HCC accompanied by hepatitis B virus (HBV), 43 (27%); hepatitis C virus (HCV), 96 (61%); HBV, HCV, 5 (3%) and non B non C, 15 (9%). One hundred and fourteen (72%) patients were male with a tumor radius of 2 (range, 0.4–3) cm; number of tumors, 2 (range, 1–186); alpha-fetoprotein (AFP) 28.5 (range, 1.3–12,727) and DCP 42 (range, 5–20,600). The tumors were well, moderately and poorly differentiated in 22 (14%), 105 (66%) and 24 (15%) patients, respectively. Among the patients, 124 (78%) and 132 (83%) were within the MC and KC, respectively. One-, three- and five-year survival rates associated with tumors within and beyond the MC were 87%, 81% and 79% vs. 94%, 76%, and 70%, respectively (P=0.430) and recurrence rates were significantly lower in patients within MC than in patients beyond MC (P<0.001). One-, three- and five-year survival rates associated with tumors within and beyond KC were 89%, 85%, and 83% vs. 89%, 58%, and 50%, respectively (P<0.001) and recurrence rates were 2%, 3%, and 4% vs. 21%, 37%, and 47%, respectively (P<0.001). Survival and recurrence rates were significantly higher and lower, respectively, among patients whose tumors were within, than beyond the KC. The one, three and five-year survival rates of patients with or without pretreatment were 89%, 79%, and 75% vs. 86%, 81%, and 81%, respectively (P=0.315) and recurrence rates were 6%, 10%, and 15% vs. 2%, 2%, and 2%, respectively (P=0.040). Recurrence rates were significantly higher in patients with pretreatment than in those without pretreatment.
Conclusions: Outcomes after LT were favorable for patients with small HCC that meet MC criteria or are less biologically malignant.
