HEPATOCELLULAR CARCINOMA AND LIVER TRANSPLANTATION: AN ANALYSIS OF PROGNOSTIC FACTORS

Abstract

O368 Aims: Orthotopic liver transplantation (OLT) is the only curative treatment of inoperable hepatocellular carcinoma (HCC). The prognosis after OLT depends on the characteristics of the primary tumor such as size, grading and vascular invasion and it is still controversial which patient to transplant. We performed an uni- and multivariate analysis of prognostic factors in 64 HCC patients undergoing OLT. Methods: Between 1998 and 12/2003 64 patients suffering from HCC were transplanted. 34 received a neoadjuvant treatment by transarterial chemoembolisation (TACE) with Mitomycin C and Lipiodol at intervalls of 6 weeks (mean 4.9 sessions) while waiting for OLT (male 27, female 7; age 58,5±7.3 years; liver function Child A 76%, Child B 18%, Child C 6%; Milan Criteria (MC) fulfilled 32%, beyond MC 68%). The control group consisted of 30 patients without (19/30) or other (11/30) pretreatment (male 20, female 10; age 56.1±6.4 years; liver function Child A 33%, Child B 20%, Child C 47%; Milan Criteria (MC) fulfilled 60%, beyond MC 40%). The median follow up was 672 days. Univariate and multivariate analyses of several prognostic factors for recurrence-free survival after OLT were performed using Kaplan Meier method and Cox regression, respectively. Results: Recurrence-free survival (5 years) of all patients was 45%, 84% (TACE group) and 23% (non TACE group), respectively. 16/64 patients died after OLT, 6/16 (37%) due to HCC recurrence, 10/16 (63%) due to HCC unrelated causes. 1/34 (3%) patient with TACE pretreatment, but 9/30 (30%) without TACE died due to HCC unrelated causes. HCC recurrence after OLT occurred in 3/34 (9%) patients in the TACE group (2 patients are still alive), and 5/30 (17%) patients in the non-TACE group. In the TACE group MC were fulfilled in 11/34 patients, 23/34 patients were beyond the MC, survival was comparable: 86% vs. 83%. 25/34 TACE patients had stable disease during pretreatment, all of them are recurrence-free after 3 years. 9/34 had progressive tumor under TACE, only 51% are recurrence-free (p=0.001). In the multivariate analysis only TACE vs. non TACE showed an influence on survival (p=0.008). The influence of tumor stage, MC, grading, solitary vs. multifocal growth or waiting time was not significant. The univariate analysis of prognostic factors proved statistical influence on recurrence-free survival for TACE vs. non-TACE (p=0.004) and waiting time >150 days (p=0.028). Vascular invasion (p=0.093), grading (p=0.138), tumor size (p=0.621), MC (p=0.433), and solitary vs. multifocal growth (p=0.967) had no significant influence on survival. Conclusions: Neoadjuvant treatment of HCC patients awaiting OLT influences recurrence-free survival, whereas tumor characteristics as stage, grading and MC do not. Sequential TACE without tumor progress is a strong predictor for recurrence-free survival. Even in patients with large tumors OLT may be justified if the tumor is stable during TACE pretreatment and if TACE is performed in close intervalls.