Liver transplantation in the treatment of patients with hepatocelular carcinoma

• Authors: Marek Krawczyk , Michał Grąt , Oskar Kornasiewicz , Krzysztof Zieniewicz , Paweł Nyckowski , Waldemar Patkowski , Ireneusz Grzelak , Krzysztof Dudek , Tadeusz Wróblewski , Rafał Paluszkiewicz
• Languages of publication: EN

Abstracts

EN

The aim of the study was to analyse liver transplantation results in patients with hepatocellular carcinoma, considering selected factors.Material and methods. The study group comprised 82 patients subject to liver transplantation at the Department of General, Transplant and Liver Surgery, Warsaw Medical University, due to hepatocellular carcinoma. Retrospective analysis concerned the period between 2001 and 2010. Distant survival results were evaluated, depending on whether Milan criteria were fulfilled, and the preoperative level of alpha-fetoprotein estimated. The obtained results were subject to statistical analysis. p<0.05 was considered as statistically significant.Results. Mean survival time considering patients subject to liver transplantation, due to hepatocellular carcinoma amounted to 66.7 months (95% PU 58.9-74.4), while survival without tumor recurrence - 62.3 months (95% PU 54-70.6). The one, three and five - year survival rate was 88.7%, 74.8% and 72.0%, respectively. Survival without tumor recurrence was 87.5%, 67.1% and 67.1%, respectively. The overall survival of patients fulfilling the Milan criteria (44 of 82 patients - 53.7%) was significantly longer, in comparison to patients not fulfilling the above-mentioned (74.4 and 48.3 months, respectively, p=0.025). A significant difference was also observed, considering the overall survival in the absence of cancer recurrence (72.5 and 42.4 months, respectively, p=0.007). Considering patients not fulfilling the Milan criteria who presented with preoperative alpha-fetoprotein levels > 100 ng/ml, overall survival was shorter, as compared to the mean survival rate: 32.5 and 64.4 months, respectively, p = 0.009. Similar values were obtained in case of patients without tumor recurrence (27 and 57.1 months, p=0.011).Conclusions. The obtained results confirmed the significant value of Milan criteria, when qualifying patients with hepatocellular carcinoma for liver transplantation. The above-mentioned also showed the potential value of preoperative alpha-fetoprotein level measurements, not only in the diagnostics and early hepatocellular carcinoma diagnosis (patients with cirrhosis), but also in the prediction of survival and tumor recurrence after liver transplantation.

Keywords

EN

hepatocellular carcinoma; liver transplantation; tumor recurrence; survival

• Publisher: Index Copernicus International
• Journal: Polish Journal of Surgery
• Year: 2010
• Volume: 82
• Issue: 11
• Pages: 596-602

Dates

published

1 - 11 - 2010

online

7 - 1 - 2011

Contributors

author

Marek Krawczyk

• Chair and Department of General, Transplant and Liver Surgery, Warsaw Medical University

author

Michał Grąt

• Chair and Department of General, Transplant and Liver Surgery, Warsaw Medical University

author

Oskar Kornasiewicz

• Chair and Department of General, Transplant and Liver Surgery, Warsaw Medical University

author

Krzysztof Zieniewicz

• Chair and Department of General, Transplant and Liver Surgery, Warsaw Medical University

author

Paweł Nyckowski

• Chair and Department of General, Transplant and Liver Surgery, Warsaw Medical University

author

Waldemar Patkowski

• Chair and Department of General, Transplant and Liver Surgery, Warsaw Medical University

author

Ireneusz Grzelak

• Chair and Department of General, Transplant and Liver Surgery, Warsaw Medical University

author

Krzysztof Dudek

• Chair and Department of General, Transplant and Liver Surgery, Warsaw Medical University

author

Tadeusz Wróblewski

• Chair and Department of General, Transplant and Liver Surgery, Warsaw Medical University

author

Rafał Paluszkiewicz

• Chair and Department of General, Transplant and Liver Surgery, Warsaw Medical University

References

• Rustgi VK: Epidemiology of hepatocellular carcinoma. Gastroenterol Clin N Am 1987; 16: 545-51.
• Thomas MB, Abbruzzese JL: Opportunities for targeted therapies in hepatocellular carcinoma. J Clin Oncol 2005; 23: 8093.[Crossref][PubMed]
• Parkin MD, Laara E, Muir CS: Estimates of the worldwide frequency of sixteen major cancers in 1980. Int J Cancer 1988; 41: 184.
• Moray G, Karakayali F, Yilmaz U et al.: Expanded Criteria for Hepatocellular Carcinoma and Liver Transplantation. Transplant Proc 2007; 39: 1171-74.[PubMed][Crossref]
• Baccarani U, Adani GL, Avellini C et al.: Comparison of Clinical and Pathological Staging and Long-Term Results of Liver Transplantation for Hepatocellular Carcinoma in a Single Transplant Center. Transplant Proc 2006; 38: 1111-13.[Crossref]
• Krawczyk M: Hepatocellular carcinoma. Med Sci Rev Hepatol 2008; 8: 92-99.
• Yu L, Sloane DA, Guo C et al.: Risk Factors for Primary Hepatocellular Carcinoma in Black and White Americans in 2000. Clin Gastroenterol Hepatol 2006; 4: 355-60.
• Marrero JA, Fontana RJ, Fu S et al.: Alcohol, tobacco and obesity are synergistic risk factors for hepatocellular carcinoma. J Hepatology 2005; 42: 218-24.
• Kew MC: Epidemiology of hepatocellular carcinoma. Toxicology 2002; 27: 35-38.[Crossref]
• Baccarani U, Benzoni E, Adani GL et al.: Superiority of Transplantation Versus Resection for the Treatment of Small Hepatocellular Carcinoma. Transplant Proc 2007; 39: 1898-1900.[Crossref][PubMed]
• Adam R, Del Gaudio M: Evolution of liver transplantation for hepatocellular carcinoma. J Hepatology 2003: 39: 888-95.
• Kanematsu T, Furui J, Yanaga K et al.: A 16-year experience in performing hepatic resection in 303 patients with hepatocellular carcinoma: 1985-2000. Surgery 2002; 131: 153-58.
• Suehiro T, Terashi T, Shiotani S et al.: Liver transplantation for hepatocellular carcinoma. Surgery 2002; 131: 190-94.
• Mazzaferro V, Regalia E, Doci R et al.: Liver transplantation for the treatment of small hepatocellular carcinoma in patients with cirrhosis. N Engl J Med 1996; 334: 693-99.
• Llovet JM, Bruix J, Fuster J et al.: Liver transplantation for small hepatocellular carcinoma; the tumour-node-metastases classification does not have prognostic power. Hepatology 1998; 27: 1572-77.[Crossref]
• Shetty K, Timmins K, Brensinger C et al.: Liver transplantation for hepatocellular carcinoma validation of present selection criteria in predicting outcome. Liver Transplant 2004; 10: 911-18.[Crossref]
• Kondili LA, Lala A, Gunson B et al.: Primary hepatocellular cancer in the explanted liver: Outcome of transplantation and risk factors for HCC recurrence. EJSO 2007; 33: 868-73.[WoS][Crossref]
• Carr BI, Kanke F, Wise M et al.: Clinical evaluation of lens culinaris agglutinin-reactive alpha-fetoprotein and des-gamma-carboxy prothrombin in histologically proven hepatocellular carcinoma in United States. Dig Dis Sci 2007; 52: 776-82.[Crossref][WoS]
• Sherman M: The resurrection of alphafetoprotein. J Hepatology 2010; 52: 939-940.[WoS]
• Ioannou GN, Perkins JD, Carithers RL: Liver Transplantation for Hepatocellular Carcinoma: Impact of the MELD Allocation System and Predictors of Survival. Gastroenterology 2008; 134: 1342-51.
• Herrero JI, Sangro B, Quiroga J et al.: Influence of Tumor Characteristics on the Outcome of Liver Transplantation Among Patients With Liver Cirrhosis and Hepatocellular Carcinoma. Liver Transplant 2001; 7: 631-36.[Crossref]
• Zieniewicz K, Patkowski W, Nyckowski P et al.: Results of liver transplantation for hepatocellular cancer. Ann Transplant 2007; 12: 11-14.
• Llovet JM, Fuster J, Bruix J: Intention-to-treat analysis of surgical treatment for early hepatocellular carcinoma: resection versus transplantation. Hepatology 1999; 30: 1434-40.[PubMed][Crossref]
• 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.[WoS][PubMed][Crossref]

Identifiers

DOI

10.2478/v10035-010-0090-1