Details

Autor(en) / Beteiligte

• Chan, See Ching
• Fan, Sheung Tat
• Chok, Kenneth S. H.
• Cheung, Tan To
• Chan, Albert C. Y.
• Fung, James Y. Y.
• Poon, Ronnie T. P.
• Lo, Chung Mau

Titel

Survival advantage of primary liver transplantation for hepatocellular carcinoma within the up-to-7 criteria with microvascular invasion

Ist Teil von

• Hepatology international, 2012-06, Vol.6 (3), p.646-656

Ort / Verlag

India: Springer-Verlag

Erscheinungsjahr

2012

Link zum Volltext

Quelle

Alma/SFX Local Collection

Beschreibungen/Notizen

• Purpose Microvascular invasion of hepatocellular carcinoma (HCC) is considered a poor prognostic factor of liver resection (LR) and liver transplantation (LT), but its significance for lesions within the up-to-7 criteria is unclear. This study investigated the survival benefit of primary LT against LR for HCC with microvascular invasion and within the up-to-7 criteria. Methods Adult patients who underwent LR or LT as the primary treatment for HCC were included for study. Patients with prior local ablation, neoadjuvant systemic chemotherapy, targeted therapy, positive resection margin, or metastatic spread were excluded. Results There were 471 LR patients and 95 LT recipients (70 with living donor, 25 with deceased donor). Seventy-seven (81.1%) LT recipients had HCC within the up-to-7 criteria. Twenty-five (26.3%) LT recipients had HCC with either macrovascular ( n  = 4) or microvascular ( n  = 21) invasion. The 5-year survival rate was 85.7% for LT recipients with HCC within the up-to-7 criteria, unaffected by the presence or absence of vascular invasion (88.2 vs. 85.1%). The rate was comparable with that of LR patients with HCC without vascular invasion (81.2%, p 0.227), but far superior to that of LR patients with lesions with vascular invasion (50.0%, p  < 0.0001). Overall survivals were compromised by multiple tumors [odds ratio (OR) 1.902, confidence interval (CI) 1.374–2.633, p  = 0.0001], vascular invasion (OR 2.678, CI 1.952–3.674, p  < 0.0001), blood transfusion (OR 2.046, CI 1.337–3.131, p  = 0.001), and being beyond the up-to-7 criteria (OR 1.457, CI 1.041–2.037, p  = 0.028). LT was a favorable factor for survival (OR 0.243, CI 0.130–0.454, p  < 0.0001). Conclusion Primary LT for HCC with microvascular invasion and within the up-to-7 criteria doubled the chance of cure as compared with LR.