Liver transplantation for patients with hepatocellular carcinoma at the Liver Cancer Institute of Fudan University, China.
ABSTRACT Selection of patients with hepatocellular carcinoma (HCC) for orthotopic liver transplantation (OLT) remains controversial. Since there is a trend to expand the transplant criteria for HCC patients, we reviewed the data of patients with HCC who had received OLT at our institute to determine their survival and prognostic factors.
A total of 67 patients with HCC who had undergone OLT from April 2001 through December 2003 were reviewed retrospectively. Selection OLT candidates with HCC was dependent on the anatomical characteristics and/or the severity of underlying liver cirrhosis. The 67 patients were followed up for more than 6 months after transplantation. Their survival rate was calculated by the Kaplan-Meier method. Univariate and multivariate analyses using the Cox proportional hazards regression model were performed to reveal the factors affecting the survival rate.
No perioperative death occurred in this series. The 1- and 2-year cumulative survival rates were 90.0% and 65.6%, and the disease-free survival (DFS) rates were 77.5% and 62.5% respectively. Univariate analysis revealed the tumor size, portal vein tumor thrombus (PVTT), serum alpha-fetoprotein level, bilobular distribution of tumors, pTNM stage and histological differentiation were statistically significant factors affecting the DFS (P < 0.05). Multivariate analysis showed tumor size and PVTT were independent and statistically significant factors affecting the DFS (P = 0.005 and 0.010, respectively). In this series, all but 2 received systemic chemotherapy, among them 13 had tumor recurrence within 8 months after OLT.
OLT is indicated for patients with HCC, even for some patients with end-stage liver disease who may survive longer without tumor recurrence. Adjuvant chemotherapy may decrease the recurrence of HCC after OLT.
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ABSTRACT: The prognostic role of tumor biological markers (biomarkers) in predicting recurrence of hepatocellular carcinoma (HCC) was investigated in this study, the results of which may help to select appropriate candidates for liver transplantation (LT). Tissue samples from 82 HCC patients with cirrhosis who had undergone LT were immunohistochemically stained with antibodies of anti-CD147, anti-matrix metalloproteinases-2 (MMP-2), MMP-9 and anti-vascular endothelial growth factor (VEGF). Tumor microvessel density (MVD) was evaluated by using CD34. Multivariate Cox regression analysis was performed to identify the relevant prognostic factors. A significant correlation was found between the expression of CD147, VEGF, MMP-2, MMP-9 and MVD-CD34 in HCC. Tumor CD147 expression (P < 0.0001), tumor MVD-CD34 (P < 0.0001), MMP-9 in stromal compartment (P = 0.0257) and tumor VEGF expression (P = 0.0335) were significantly associated with the recurrence in HCC patients after LT. Univariate analysis showed that strong CD147 expression and high MVD-CD34 were significantly associated with poor tumor recurrence-free survival after LT (P < 0.0001). Multivariate analysis indicated that CD147 (P = 0.0001), MVD-CD34 (P = 0.0118), MMP-2 (P = 0.0312) and MMP-9 (P = 0.0280) in stromal compartment were all significant predictors in predicting HCC recurrence, while VEGF, MMP-2 and MMP-9 in tumor compartment were not significantly associated with poor prognosis. The tumor biomarkers CD147 and MVD-CD34 are more feasible markers for rational selection of LT candidates with HCC. MMP-9 and MMP-2 expression in stromal compartment, combined with pTNM tumor grade, may be helpful in predicting poor prognosis in HCC patients after LT.Cancer biology & therapy 07/2006; 5(7):808-14. · 3.29 Impact Factor
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ABSTRACT: Foreign residents seeking liver transplantation in China are not uncommon. The outcomes of these people have not been well reported, and the results remain unclear. A total of 64 adults [26 with end-stage liver disease (ESLD) and 38 with hepatocellular carcinoma (HCC)] who underwent donation after cardiac death (DCD) liver transplantation in China during a 5-year period were reviewed. The median follow-up period was 15.6 months. The estimated 3-month mortality rate was 4.7%. The overall survival (OS) rate of the entire patient group at 1 and 3 years was 80.3% and 63.6%, respectively. The 1- and 3-year graft survival rates were 78.5% and 64.4%, respectively. For ESLD, the 1- and 3-year OS rates were 82.5% and 82.5%, respectively. For HCC, the 1- and 3-year survival rates were 78.3% and 50.8%, respectively. The 1- and 3-year OS rates for the HCC patients who were beyond the Milan criteria (MC; n = 24) versus those who met the MC (n = 14) were 69.8% and 28.2% versus 92.9% and 92.9% (P = 0.0032). The 1- and 3-year disease-free survival rates for those beyond the MC versus those who met the MC were 56.8% and 39.0% versus 92.3% and 92.3% (P = 0.0089). The incidence of complications was 59.4%. Biliary complications (n = 24, 37.5%), vascular complications (n = 24, 37.5%), and infection (n = 16, 25%) were the 3 most frequent transplant-related complications. There were 10 patients with unsolved biliary complications, and a total of 5 patients died of posttransplant infections. In conclusion, patients with ESLD or HCC within the MC seeking DCD liver transplants in China obtained survival results comparable to those of other major cohorts from Western countries. However, a considerably high incidence of biliary complications, vascular complications, and infection substantially threatening the lives of patients is notable. Furthermore, the associated cost impact on medical resource utilization should not be overlooked.Liver Transplantation 11/2009; 15(11):1579-85. · 3.94 Impact Factor
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ABSTRACT: To compare post-orthotopic liver transplantation (OLT) survival between patients with recurrent hepatocellular carcinoma (HCC) after partial hepatectomy and those who received de novo OLT for HCC and to assess the risk factors associated with post-OLT mortality. From July 2003 to August 2005, 77 consecutive HCC patients underwent OLT, including 15 patients with recurrent HCC after partial hepatectomy for tumor resection (the rescue OLT group) and 62 patients with de novo OLT for HCC (the de novo OLT group). Thirty-three demographic, clinical, histological, laboratory, intra-operative and post-operative variables were analyzed. Survival was calculated by the Kaplan-Meier method. Univariable and multivariable analyses were also performed. The median age of the patients was 49.0 years. The median follow-up was 20 mo. Three patients (20.0%) in the rescue OLT group and 15 patients (24.2%) in the de novo OLT group died during the follow-up period (P = 0.73). The 30-day mortality of OLT was 6.7% for the rescue OLT group vs 1.6% for the de novo OLT group (P = 0.27). Cox proportional hazards model showed that pre-OLT hyperbilirubinemia, the requirement of post-OLT transfusion, the size of the tumor, and family history of HCC were significantly associated with a higher hazard for mortality. There are no significant differences in survival/mortality rates between OLT as de novo therapy and OLT as a rescue therapy for patients with hcc. Pre-OLT hyperbilirubinemia, post-OLT requirement of transfusion, large tumor size and family history of HCC are associated with a poor survival outcome.World Journal of Gastroenterology 08/2008; 14(27):4370-6. · 2.55 Impact Factor