AFPlevelandhistologicdifferentiationpredict thesurvivalofpatientswithlivertransplantation forhepatocellularcarcinoma

摘要

BACKGROUND: In  liver  transplantation  or  resection  for hepatocellular carcinoma (HCC), patient selection depends on morphological features. In patients with HCC, we performed a clinicopathological analysis of risk factors that affected survival after liver transplantation. METHODS: In 389 liver transplantations performed from 2004 to 2010, 102 were for HCC patients. Data were collected retrospectively  from  the  Organ  Transplantation  Center Database. Variables were as follows: age, gender, preoperative alpha-fetoprotein (AFP) levels, Child-Pugh and MELD scores, prognostic  staging  criteria  (Milan  and  UCSF),  etiology, number of tumors, the largest tumor size, total tumor size, multifocality,  intrahepatic  portal  vein  tumor  thrombosis, bilobarity, and histological differentiation. RESULTS: One  hundred  and  two  patients  were  evaluated. The 5-year overall survival rate was 56.5%. According to the UCSF criteria, 63% of the patients were within and 37% were beyond UCSF (P=0.03). Ten patients were excluded (one with ifbrolamellary HCC and 9 because of early postoperative death without HCC recurrence), and 92 patients were assessed. The mean age of the patients was 56.5±6.9 years. Sixty-two patients underwent  living  donor  liver  transplantations.  The  mean follow-up time was 29.4±22.6 months. Fifteen patients (16.3%) died in the follow-up period due to HCC recurrence. Univariate analysis showed that AFP level, intrahepatic portal vein tumor thrombosis, histologic differentiation and UCSF criteria were signiifcant factors related to survival and tumor recurrence. The 5-year estimated overall survival rate was 62.2% in all patients. According to the UCSF criteria, and the 5-year overall survival rate was 66.7% within and 52.7% beyond the criteria (P=0.04). Multivariate analysis showed that AFP level and poor differentiation were independent factors. CONCLUSIONS: For  proper  patient  selection  in  liver  trans-plantation for HCC, prognostic criteria related to tumor biology (especially AFP level and histological differentiation) should be considered. Poor differentiation and higher AFP levels are indicators of poor prognosis after liver transplantation.