Prognosis of Hepatocellular Carcinoma after Liver Transplantation: Comparative Analysis with Partial Hepatectomy
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Background: Liver transplantation (LT) is the treatment of choice for hepatocellular carcinoma (HCC). The aim of this study was to investigate the recurrence rate of HCC after LT and prognostic factors for recurrence by comparing LT with non-transplanted resection. Methods: The participants were 338 patients who underwent LT between 1996 and 2012 at Seoul National University Hospital (LT group) and 520 HCC patients who underwent partial hepatectomy between 1995 and 2006 (control group, non-LT group). Results: In the LT group, 68 of 338 patients (19.8%) showed relapse, and the recurrence rate was lower than that in the non-LT group (64.9%, 357/520, p < .001). Stratification analysis by American Joint Committee on Cancer (AJCC) stage showed that the stage I-II LT group had a lower recurrence rate than the non-LT group. Univariate comparative analysis demonstrated that multiplicity of tumor, tumor size, gross type, Edmondson-Steiner (ES) nuclear grade, extent of tumor, angioinvasion, AJCC stage, Milan criteria, University of California at San Francisco criteria on explant pathology (all p < .001), positive expression of cytokeratin 19 (p = .002), and preoperative α-fetoprotein (AFP) (p < .001) were predictors of tumor recurrence. In multivariate analysis, LT, preoperative AFP, multiplicity of tumor, extent of tumor, size of tumor, and ES nuclear grade were independent prognostic factors. Conclusions: LT might have a protective effect against the late recurrence of stage I-II HCC compared to non-LT, and the prognostic factors for recurrence were similar to previously well-known prognostic factors for HCC.
Abstract
Background: Liver transplantation (LT) is the treatment of choice for hepatocellular carcinoma (HCC). The aim of this study was to investigate the recurrence rate of HCC after LT and prognostic factors for recurrence by comparing LT with non-transplanted resection. Methods: The participants were 338 patients who underwent LT between 1996 and 2012 at Seoul National University Hospital (LT group) and 520 HCC patients who underwent partial hepatectomy between 1995 and 2006 (control group, non-LT group). Results: In the LT group, 68 of 338 patients (19.8%) showed relapse, and the recurrence rate was lower than that in the non-LT group (64.9%, 357/520, p < .001). Stratification analysis by American Joint Committee on Cancer (AJCC) stage showed that the stage I-II LT group had a lower recurrence rate than the non-LT group. Univariate comparative analysis demonstrated that multiplicity of tumor, tumor size, gross type, Edmondson-Steiner (ES) nuclear grade, extent of tumor, angioinvasion, AJCC stage, Milan criteria, University of California at San Francisco criteria on explant pathology (all p < .001), positive expression of cytokeratin 19 (p = .002), and preoperative α-fetoprotein (AFP) (p < .001) were predictors of tumor recurrence. In multivariate analysis, LT, preoperative AFP, multiplicity of tumor, extent of tumor, size of tumor, and ES nuclear grade were independent prognostic factors. Conclusions: LT might have a protective effect against the late recurrence of stage I-II HCC compared to non-LT, and the prognostic factors for recurrence were similar to previously well-known prognostic factors for HCC.
참고문헌 (25)
- Parkin DM, "Estimating the world cancer burden: Globocan 2000", Int J Cancer, 94, pp.153~156 (2001)
- Mazzaferro V, "Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis", N Engl J Med, 334, pp.693~699 (1996)
- Tan KC, "Experience of orthotopic liver transplantation and hepatic resection for hepatocellular carcinoma of less than 8 cm in patients with cirrhosis", Br J Surg, 82, pp.253~256 (1995)
- McPeake JR, "Liver transplantation for primary hepatocellular carcinoma: tumor size and number determine outcome", . J Hepatol, 18, pp.226~234 (1993)
- Yao FY, "Liver transplantation for hepatocellular carcinoma: expansion of the tumor size limits does not adversely impact survival", Hepatology, 33, pp.1394~1403 (2001)
- Gondolesi GE, "Adult living donor liver transplantation for patients with hepatocellular carcinoma: extending UNOS priority criteria", Ann Surg, 239, pp.142~149 (2004)
- Todo S, "Japanese Study Group on Organ Transplantation. Living donor liver transplantation for adult patients with hepatocellular carcinoma: experience in Japan", Ann Surg, 240, pp.451~459 (2004)
- Lee SG, "Expanded indication criteria of living donor liver transplantation for hepatocellular carcinoma at one large-volume center", Liver Transpl, 14, pp.935~945 (2008)
- Miltiadous O, "Progenitor cell markers predict outcome of patients with hepatocellular carcinoma beyond Milan criteria undergoing liver transplantation", J Hepatol, 63, pp.1368~1377 (2015)
- 한국 간 암 스터디그룹, "2014 KLCSG-NCC Korea Practice Guideline for the Management of Hepatocellular Carcinoma", Gut and Liver, 9(3), pp.267~317 (2015), 거트앤리버 발행위원회
- Hwang S, "Liver transplantation for adult patients with hepatocellular carcinoma in Korea: comparison between cadaveric donor and living donor liver transplantations", Liver Transpl, 11, pp.1265~1272 (2005)
- Edge SB, "The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM", Ann Surg Oncol, 17, pp.1471~1474 (2010)
- "The general rules for the clinical and pathological study of primary liver cancer", Jpn J Surg, 19, pp.98~129 (1989), Liver Cancer Study Group of Japan
- "A language and environment for statistical computing" (2015)[URL]
- Hothorn T, "Implementing a class of permutation tests: the coin package", J Stat Softw, 28, pp.1~23 (2008)
- Hothorn T, "A Lego system for conditional inference", Am Stat, 60, pp.257~263 (2006)
- Kaido T, "Long-term outcomes of hepatic resection versus living donor liver transplantation for hepatocellular carcinoma: a propensity score-matching study", Dis Markers, 2015, pp.425926~ (2015)
- Imamura H, "Risk factors contributing to early and late phase intrahepatic recurrence of hepatocellular carcinoma after hepatectomy", J Hepatol, 38, pp.200~207 (2003)
- Scortegagna E, Jr, "Hepatocellular carcinoma recurrence pattern following liver transplantation and a suggested surveillance algorithm", Clin Imaging, 40, pp.1131~1134 (2016)
- Attard G, "Utilizing circulating tumor cells: challenges and pitfalls", Curr Opin Genet Dev, 21, pp.50~58 (2011)
- Zhang Y, "Circulating tumor cells in hepatocellular carcinoma: detection techniques, clinical implications, and future perspectives", Semin Oncol, 39, pp.449~460 (2012)
- Zhang Y, "Targeting of circulating hepatocellular carcinoma cells to prevent postoperative recurrence and metastasis", World J Gastroenterol, 20, pp.142~147 (2014)
- Donat M, "Impact of histological factors of hepatocellular carcinoma on the outcome of liver transplantation", Transplant Proc, 48, pp.1968~1977 (2016)
- Mejia GA, "Correlation between the radiologic and histologic size of hepatocellular carcinoma in patients eligible for liver transplantation", Transplant Proc, 38, pp.1394~1395 (2006)
- El Moghazy W, "Incidence, characteristics, and prognosis of incidentally discovered hepatocellular carcinoma after liver transplantation", J Transplant, 2016, pp.1916387~ (2016)