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Transplant Proc. 2014 Sep;46(7):2287-9. doi: 10.1016/j.transproceed.2014.07.031.

Survival benefit of transplantation for recurrence of hepatocellular carcinoma after liver resection.

Author information

1
Unità di Chirurgia Epatobiliare e Trapianto Epatico, Azienda, Università di Padova, Padua, Italy.
2
Unità di Chirurgia Epatobiliare e Trapianto Epatico, Azienda, Università di Padova, Padua, Italy. Electronic address: alessandro.vitale@unipd.it.
3
Unità di Emergenze Trapiantologiche, Azienda, Università di Padova, Padua, Italy.
4
Unità di Trapianto Multiviscerale, Azienda, Università di Padova, Padua, Italy.

Abstract

BACKGROUND:

Liver transplantation (LT) for hepatocellular carcinoma (HCC) can be used for tumor recurrence after liver resection (LR) both for initially transplant-eligible patients as conventional salvage therapy (ST) and for non-transplant-eligible patients (beyond Milan criteria) with a goal of downstaging (DW). The aim of this study was to compare the intention-to-treat (ITT) survival rates of patients who are listed for LT, according to these two strategies.

METHODS:

We analyzed a prospective database of 399 consecutive patients who underwent hepatic resection for HCC from 2002 to 2011 to identify patients included in the waiting list for tumor recurrence. Intention-to-treat (ITT) survivals were compared with those of patients resected for HCC within and beyond Milan criteria in the same period and not included in the LT waiting list.

RESULTS:

The study group consisted of 42 patients, 28 in the ST group (within Milan) and 14 in the DW group (beyond Milan). The 5-year ITT survival rate was similar between the 2 groups, being 64% for ST and 60% for DW (P=.84). Twenty-five patients (15 ST and 10 DW) underwent LT, 13 (10 ST and 3 DW) were still awaiting LT, 4 (3 ST and 1 DW) dropped out of the waiting list because of tumor progression, and 7 (5 ST [33%] and 2 DW [20%]) had tumor recurrence. The 5-year ITT survival of ST patients was similar to that of 252 in-Milan HCC patients resected only (P=.3), whereas 5-year ITT survival of DW patients was significantly higher (P<.01) than that of 105 beyond-Milan HCC patients resected only.

CONCLUSIONS:

LR seems to be a safe and effective therapy both as alternative to transplantation and as downstaging strategy for intermediate-advanced HCC. The survival benefit of salvage LT, however, seems to be higher in the 2nd than in the 1st group.

[Indexed for MEDLINE]

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