https://aasldpubs.onlinelibrary.wiley.com/doi/pdf/10.1053/jhep.2001.24563

Liver transplantation for hepatocellular carcinoma: Expansion of the tumor size limits does not adversely impact survival

https://aasldpubs.onlinelibrary.wiley.com/doi/epdf/10.1053/jlts.2002.34892

Liver transplantation for hepatocellular carcinoma: comparison of the proposed UCSF criteria with the Milan criteria and the Pittsburgh modified TNM criteria.

Objective This study compares the results of liver transplantation (LTx) and liver resection (LR) for hepatocellular carcinoma (HCC) to test the widespread hypothesis that LTx is the preferable approach for small HCCs Summary Background Data With respect to scarcity of donor organs and poor results, LTxs for large HCCs are obsolete Small HCC transplantations have been reported to result in an excellent survival rate However, the data of comparative studies are controversial Methods Patients who were treated curatively by LTx (n = 50) or LR (n = 52) for HCC were included in this retrospective study Survival and freedom from recurrence were analyzed Patients were stratified according to prognostic factors (pT classification, tumor size, number of tumor nodules, vascular infiltration, and cirrhosis) Results Overall, after LTx and LR the 3-year survival rate and recurrence rate were not significantly different In the Cox analysis, tumor size (p = 002) and vascular infiltration (p = 004) were independent variables after LTx, whereas after LR, none of the tested prognostic parameters was significant With regards to recurrence, tumor size was the only independent factor, after both LTx and LR (p = 002, respectively) Directly comparing the two therapeutic approaches, a 3-year survival rate in pT 1/2, oligocentric (1-5 nodules), and oligocentric and small tumors proved to be superior after LTx The recurrence rate after LTx was superior to LR in pT 1/2 and oligocentric tumors Remarkably, for small (≤5 cm) tumors, LTx and LR resulted in a similar 3-year survival rate and freedom from recurrence Conclusions According to our analysis, the oncological advantage of LTx compared with LR is questionable This applies especially for small tumors Superior results of LTx in early stage HCC and particularly in oligocentric tumors may be attributed to incorrect preoperative diagnosis Nevertheless, LTx is a reasonable treatment for patients with early stage tumors if a LR is impossible because of tumor localization or poor functional hepatic capacity

Survival and recurrence after liver transplantation versus liver resection for hepatocellular carcinoma: a retrospective analysis.

Predictors of microvascular invasion in patients with hepatocellular carcinoma who are candidates for orthotopic liver transplantation

BACKGROUND

The aim of this collaborative study was to compare the long term results of hepatic resection (Hx) with those of orthotopic liver transplantation (OLTx) in large numbers of cirrhotic patients with hepatocellular carcinoma (HCC) and to delineate the roles of these two surgical treatments.



METHODS

The databases of the National Cancer Center Hospital in Japan and the University of Pittsburgh Medical Center in the U. S. were exchanged and 294 cirrhotic patients who underwent curative Hx and 270 cirrhotic patients who underwent curative OLTx were selected for comparison.



RESULTS

The mortality rate within 30 days and that within 150 days after Hx were significantly lower than those after OLTx (P = 0.001 and P = 0.00007, respectively). Overall survival was similar between the Hx group and the OLTx group (P = 0.40). When compared in the HCC patients without macroscopic vascular invasion and lymph node metastases, the overall survival rate after OLTx was significantly higher than that after Hx (P = 0.006). However, this difference was not significant between the patients with Child-Pugh Grade A tumors in the Hx group and all patients (majority with Child-Pugh Grade C tumors) in the OLTx group (P = 0.25). Tumor free survival after OLTx was significantly higher than that after Hx (P 5 cm and those with macroscopic vascular invasion, the tumor free survival rate was similar between the Hx group and the OLTx group.



CONCLUSIONS

In the face of organ shortage, HCC developing in a well compensated cirrhotic liver initially may be treated with Hx. However, the authors believe OLTx should be applied selectively to those patients with tumor recurrence and/or progressive hepatic failure. Cancer 1999;86:1151–8. © 1999 American Cancer Society.

/pdf/should-hepatomas-be-treated-with-hepatic-resection-or-2muiud4pyq.pdf

Should hepatomas be treated with hepatic resection or transplantation

Of 176 hepatic transplants performed from 1986 to December 1992, 27 patients had small hepatocellular carcinoma (< or = 5 centimeters) complicating cirrhosis of the liver. All patients were asymptomatic for the hepatic malignancy and the diagnosis was established in each instance preoperatively by means of serial sonographic scans and alpha-fetoprotein levels. Cirrhosis was classified as Child's A in eight instances, as Child's B in 16 and Child C's in three. The cause was alcoholic in three patients, posthepatitic in 21 patients (eight hepatitis B virus [HBV] positive and 13 hepatitis C virus [HCV] positive) and undetermined in three. The in-hospital mortality rate was 11 percent (three of 27). Additionally, five patients died at different intervals after transplantation: only two died of neoplastic recurrence at 12 and 32 months, respectively (7.4 percent rate). Actuarial survival rates were 82 percent at one year and 71 percent at three years, with a mean follow-up period of 32 months (range six to 78 months). Morbidity related to the procedure was a relevant problem: 21 percent of the patients had prompt resumption of normal life while 37 percent required repeated hospitalization and 42 percent required strict control on an outpatient basis. The most frequent problem was HBV or HCV reinfection of the grafted liver, which occurred in 42 percent. Based on this experience, transplantation of the liver has shown an excellent oncologic accuracy for small hepatocellular carcinoma in cirrhosis of the liver, thus representing the most rational surgical procedure for patients with Child's B and Child's C cirrhosis classification. The relevant mortality and morbidity rates, strictly related to this procedure, suggest other options as more appropriate in those with Child A cirrhosis at this time.

The role of transplantation in small hepatocellular carcinoma complicating cirrhosis of the liver.

Insulin-like growth factors [IGF I and II or somatomedins (SMS)] are polypeptides chemically and biologically correlated with insulin. The main source of synthetic activity and secretion is the liver, although many other tissues have been demonstrated to synthesize SMS [5]. In the circulation, they are not present in a free form, but are mostly bound to a specific carrier protein independently synthesized in the liver. Hepatic or extrahepatic storage organs have not been demonstrated; the half life of the SMS-binding protein complex is between 3 and 4 [1]. Synthesis of SMS is regulated by GH, insulin, thyroxine and nutrition (caloric and protein intake, and nitrogen balance). The role of corticosteroids is still a matter of debate: in patients treated with steroids SMS blood levels have been shown to be within normal limits, while biological activity has been demonstrated to be significantly reduced by SMS inhibitors, probably induced by corticosteroid therapy [2].

Somatomedin C (IGF I) plasma levels after orthotopic liver transplantation (OLT) in end-stage cirrhotic patients.

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The role of transplantation in small hepatocellular carcinoma complicating cirrhosis of the liver.

Somatomedin C (IGF I) plasma levels after orthotopic liver transplantation (OLT) in end-stage cirrhotic patients.