Role of immunosuppression and tumor differentiation in predicting recurrence after liver transplantation for hepatocellular carcinoma: A multicenter study of 412 patients
Open Access
- 1 January 2006
- journal article
- research article
- Published by Baishideng Publishing Group Inc. in World Journal of Gastroenterology
- Vol. 12 (45), 7319-25
- https://doi.org/10.3748/wjg.v12.i45.7319
Abstract
AIM: To assess pre-orthotopic liver transplantation (OLT) factors that could be evaluated pre-operatively or controlled post-operatively associated with hepatocellular carcinoma (HCC) recurrence and disease-free survival after liver transplantation (LT). METHODS: Four hundred and twelve patients transplanted for HCC between 1988 and 1998 in 14 French centers, who survived the postoperative period were studied. Kaplan Meier estimates were calculated for 24 variables potentially associated with recurrence of HCC. Uni- and multivariate analyses were conducted to identify independent predictors of recurrence. RESULTS: Overall 5-year disease-free survival was 57.1%. By univariate analysis, variables associated with disease-free survival were: presence of cirrhosis (P = 0.001), etiology of liver disease (P = 0.03), α fetoprotein level (< 200, 200 to 2000, or > 2000; P < 0.0001), γ-GT activity (N, N to 2N or > 2N; P = 0.02), the number of nodules (1, 2-3 or ≥ 4; P = 0.02), maximal diameter of the largest nodule (< 3 cm, 3 to 5 cm or > 5 cm; P < 0.0001), the sum of the diameter of the nodules (< 3 cm, 3 to 5 cm, 5 to 10 cm or >10 cm; P < 0.0001), bi-lobar location (P = 0.01), preoperative portal thrombosis (P < 0.0001), peri-operative treatment of the tumor (P = 0.002) and chemoembolization (P = 0.03), tumor differentiation (P = 0.01), initial type of calcineurin inhibitor (P = 0.003), the use of antilymphocyte antibodies (P = 0.02), rejection episodes (P = 0.003) and period of LT (P < 0.0001). By multivariate analysis, 6 variables were independently associated with HCC recurrence: maximal diameter of the largest nodule (P < 0.0001), time of LT (P < 0.0001), tumor differentiation (P < 0.0001), use of anti-lymphocyte antibody (ATG) or anti-CD3 antibody (OKT3) (P = 0.005), preoperative portal thrombosis (P = 0.06) and the number of nodules (P = 0.06). CONCLUSION: This study identifies immunosuppression, through the use of ATG or OKT3, as a predictive factor of tumor recurrence, and confirms the prognostic value of tumor differentiation.Keywords
This publication has 30 references indexed in Scilit:
- [Needle-tract seeding after ultrasound-guided puncture of hepatocellular carcinoma. A study of 150 patients].1999
- Rising Incidence of Hepatocellular Carcinoma in the United StatesNew England Journal of Medicine, 1999
- EFFECT OF SYSTEMIC CYCLOSPORINE ON TUMOR RECURRENCE AFTER LIVER TRANSPLANTATION IN A MODEL OF HEPATOCELLULAR CARCINOMA1Transplantation, 1999
- Liver Transplantation for Hepatocellular CarcinomaAnnals of Surgery, 1998
- Surgical options for hepatocellular carcinoma: resection and transplantation.1998
- Trends in primary liver cancerThe Lancet, 1998
- Increase in primary liver cancer in the UK, 1979–94The Lancet, 1997
- The prediction of risk of recurrence and time to recurrence of hepatocellular carcinoma after orthotopic liver transplantation: A pilot studyHepatology, 1997
- Liver transplantation for primary hepatocellular carcinoma: tumor size and number determine outcomeJournal of Hepatology, 1993
- Liver Resection Versus Transplantation for Hepatocellular Carcinoma in Cirrhotic PatientsAnnals of Surgery, 1993