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International Registry of Hepatic Tumors in Liver Transplantation
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Tumor Characteristics Impact on Outcome After Liver Transplantation for Hepatocellular Carcinoma: A Registry Report: The Transplantation Society XVII World Congress |
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Goran B. Klintmalm, Marlon F. Levy, Robert M. Goldstein, BoS Husberg,
Baylor University Medical Center
The International Registry of Hepatic Tumors in Liver Transplantation was established in 1992. The registry provides data on demographics, tumor characteristics, treatments, time and location of recurrences and survival. Currently 53 liver transplant centers from 21 countries have entered 553 patients in the registry. Of those patients, 410 have hepatocellular carcinoma (HCC) and 12 fibrolamellar (FLL-HCC).
Only 204 (49.8%) received adjunctive therapy. HCC was the indication for transplantation in 240 patients. Secondary disease was reported in 175 patients (47.8%). In 169 patients (41.3%) had incidental tumor. A single lesion was found in 167 patients, bilobar spread in 109 patients (26.6%), multi-focal in 209 patients (51.0%). Vascular invasion was seen in 71 patients (23.2%) The tumor size was less than 5 cm in 267 patients (65.5%).
Only 24 patients (6%) were reported with positive nodes. Well-differentiated tumors, G1, were seen in 19 patients and anaplastic, G4, in six patients. Grading was missing in 222 patients. The overall patient survival rate at one-, three-, and five-year intervals was 71%, 52% and 44%. 85 out of 182 (46.7 - 5 unknown) deaths were tumor related.
Recurrence was reported in 114 patients (29.3%). The first site of recurrence for liver was 43.1%, lungs 27.5%, adrenal 5.5%, and mediastinum 2.8%. Currently 187 patients are alive free of tumor, 17 are alive with tumor, 91 died free of tumor, 89 died with tumor. A multivariate analysis for all HCC factors, excluding FLL-HCC, shows that histolic grade G1 + 2 vs. G3 +4 is the only independent variable predicting survival (p=0.0008).
Since 222 (54.1%) of the patients lacked histologic grading, the Cox analysis rerun without histologic grade showed only vascular invasion related to patient survival (p=0.0043). Of particular interest was that for incidentally diagnosed tumors, only multifocality predicted patient survival (p=0.0018). Discussion: When determining candidacy for liver replacement as part of the cancer treatment, pre-transplant histological grading
seems to be an essential factor. Criteria that influence the response to adjunctive therapy will hopefully be determined with the growth of the registry.
The Transplantation Society XVII World Congress, July 14, 1998
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