INTRODUCTION Negative prognostic factors for HCC recurrence after liver transplant (LT) are still matter of debate. The absence of active residual tumor in the native liver, due to high effectiveness of pre-LT loco-regional treatments or liver resection, represent an intriguing prognostic factor never evaluated before. METHODS Between November 2000 and May 2009, 164 LT, with a 3 months minimum patient survival, have been performed at our Institution in patients with radiological or histological evidence of HCC on cirrhosis before LT. Thirty-four (20,7%) patients (29 males, 8 females, mean age 55,5 ± 8.1 years) did not show any evidence of active residual HCC in native liver (Group A) while 130 patients (Group B) showed active residual HCC. All patient in Group A were treated before LT with multimodal approach combining TACE (23 cases), liver resection (9), RITA (9) and PEI (7). Pre-LT tumoral diagnosis was performed with radiological criteria (20 patients), by means of liver biopsy (5 cases) according EASL Conference of Barcellona (Bruix et al., 2001) or hystological definition after liver resection (9 cases). From tumoral standpoint, 7 cases (20.6%) in Group A Vs 57 cases (43,8%) in Group B (p=0.023) was beyond the Milan criteria. RESULTS In group A, after a mean follow-up of 31.9 ± 25 months, any (0%) HCC recurrence was observed while in Group B, after a mean follow-up of 37.5 ± 27 months, HCC recurrence was demonstrated in 22 cases (16.9%, p=0.008). Overall 3 and 5 year survival was 82.5 and 82.5% in Group A while in Group B 69.8 and 65.2% respectively (p=0.021). DISCUSSION The histological absence of active residual HCC in native liver after LT, due to high effectiveness of pre-LT loco-regional treatments or liver resection, seems to be and high positive prognostic factor (100% HCC recurrence free-survival) toward HCC recurrence after LT. Further studies are required to assess the long term efficacy of pre-LT treatments for HCC.
PROGNOSTIC VALUE OF THE ABSENCE OF ACTIVE RESIDUAL HCC IN NATIVE LIVER SUCH AS PREDICTOR OF TUMOR RECURRENCE AFTER LIVER TRANSPLANTATION / Montalti, R; Di Benedetto, F; Cautero, N; Guerrini, Gp; Iemmolo, Rm; Marino, M; Serra, V; Ballarin, R; Smerieri, N; Tarantino, G; De Pietri, L; Rompianesi, G; Losi, L; Gerunda, Ge. - (2010). (Intervento presentato al convegno 16th Annual International Congress of the International Liver Transplantation Society. tenutosi a Hong Kong, China nel June 16-19, 2010).
PROGNOSTIC VALUE OF THE ABSENCE OF ACTIVE RESIDUAL HCC IN NATIVE LIVER SUCH AS PREDICTOR OF TUMOR RECURRENCE AFTER LIVER TRANSPLANTATION
Montalti R
;Rompianesi G;
2010
Abstract
INTRODUCTION Negative prognostic factors for HCC recurrence after liver transplant (LT) are still matter of debate. The absence of active residual tumor in the native liver, due to high effectiveness of pre-LT loco-regional treatments or liver resection, represent an intriguing prognostic factor never evaluated before. METHODS Between November 2000 and May 2009, 164 LT, with a 3 months minimum patient survival, have been performed at our Institution in patients with radiological or histological evidence of HCC on cirrhosis before LT. Thirty-four (20,7%) patients (29 males, 8 females, mean age 55,5 ± 8.1 years) did not show any evidence of active residual HCC in native liver (Group A) while 130 patients (Group B) showed active residual HCC. All patient in Group A were treated before LT with multimodal approach combining TACE (23 cases), liver resection (9), RITA (9) and PEI (7). Pre-LT tumoral diagnosis was performed with radiological criteria (20 patients), by means of liver biopsy (5 cases) according EASL Conference of Barcellona (Bruix et al., 2001) or hystological definition after liver resection (9 cases). From tumoral standpoint, 7 cases (20.6%) in Group A Vs 57 cases (43,8%) in Group B (p=0.023) was beyond the Milan criteria. RESULTS In group A, after a mean follow-up of 31.9 ± 25 months, any (0%) HCC recurrence was observed while in Group B, after a mean follow-up of 37.5 ± 27 months, HCC recurrence was demonstrated in 22 cases (16.9%, p=0.008). Overall 3 and 5 year survival was 82.5 and 82.5% in Group A while in Group B 69.8 and 65.2% respectively (p=0.021). DISCUSSION The histological absence of active residual HCC in native liver after LT, due to high effectiveness of pre-LT loco-regional treatments or liver resection, seems to be and high positive prognostic factor (100% HCC recurrence free-survival) toward HCC recurrence after LT. Further studies are required to assess the long term efficacy of pre-LT treatments for HCC.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
