Liver transplantation for unresectable hepatocellular carcinoma in normal livers

Hynek Mergental; Rene Adam; Bo-Goran Ericzon; Piotr Kalicinski; Ferninand Mühlbacher; Krister Höckerstedt; Jürgen L Klempnauer; Styrbjörn Friman; Christoph E Broelsch; Georges Mantion; Carlos Fernandez-Sellez; Bart van Hoek; Josef Fangmann; Jacques Pirenne; Paolo Muiesan; Alfred Königsrainer; Darius F Mirza; Jan Lerut; Olivier Detry; Yves-Ptrice Le Treut; Vincenzo Mazzaferro; Florian Löhe; Marina Berenguer; Pierre-Alain Clavien; Xavier Rogiers; Jacques Belghiti; Laslo Kóbori; Patrizia Burra; Philippe Wolf; Wolfgang Schareck; Przemyslaw Pisarski; Aksel Foss; Franco Filipponi; Marek Krawczyk; Martin Wolff; Jan M Langrehr; Keith Rolles; Neville Jamieson; Wim C J Hop; Robert J Porte

doi:10.1016/j.jhep.2012.03.022

Liver transplantation for unresectable hepatocellular carcinoma in normal livers

Hynek Mergental, Rene Adam, Bo-Goran Ericzon, Piotr Kalicinski, Ferninand Mühlbacher, Krister Höckerstedt, Jürgen L Klempnauer, Styrbjörn Friman, Christoph E Broelsch, Georges Mantion, Carlos Fernandez-Sellez, Bart van Hoek, Josef Fangmann, Jacques Pirenne, Paolo Muiesan, Alfred Königsrainer, Darius F Mirza, Jan Lerut, Olivier Detry, Yves-Ptrice Le TreutVincenzo Mazzaferro, Florian Löhe, Marina Berenguer, Pierre-Alain Clavien, Xavier Rogiers, Jacques Belghiti, Laslo Kóbori, Patrizia Burra, Philippe Wolf, Wolfgang Schareck, Przemyslaw Pisarski, Aksel Foss, Franco Filipponi, Marek Krawczyk, Martin Wolff, Jan M Langrehr, Keith Rolles, Neville Jamieson, Wim C J Hop, Robert J Porte

Immunology and Immunotherapy

Research output: Contribution to journal › Article › peer-review

36 Citations (Scopus)

Abstract

BACKGROUND & AIMS: The role of liver transplantation in the treatment of hepatocellular carcinoma in livers without fibrosis/cirrhosis (NC-HCC) is unclear. We aimed to determine selection criteria for liver transplantation in patients with NC-HCC.

METHODS: Using the European Liver Transplant Registry, we identified 105 patients who underwent liver transplantation for unresectable NC-HCC. Detailed information about patient, tumor characteristics, and survival was obtained from the transplant centers. Variables associated with survival were identified using univariate and multivariate statistical analyses.

RESULTS: Liver transplantation was primary treatment in 62 patients and rescue therapy for intrahepatic recurrences after liver resection in 43. Median number of tumors was 3 (range 1-7) and median tumor size 8 cm (range 0.5-30). One- and 5-year overall and tumor-free survival rates were 84% and 49% and 76% and 43%, respectively. Macrovascular invasion (HR 2.55, 95% CI 1.34 to 4.86), lymph node involvement (HR 2.60, 95% CI 1.28 to 5.28), and time interval between liver resection and transplantation < 12 months (HR 2.12, 95% CI 0.96 to 4.67) were independently associated with survival. Five-year survival in patients without macrovascular invasion or lymph node involvement was 59% (95% CI 47-70%). Tumor size was not associated with survival.

CONCLUSIONS: This is the largest reported series of patients transplanted for NC-HCC. Selection of patients without macrovascular invasion or lymph node involvement, or patients ≥ 12months after previous liver resection, can result in 5-year survival rates of 59%. In contrast to HCC in cirrhosis, tumor size is not a predictor of post-transplant survival in NC-HCC.

Original language	English
Pages (from-to)	297-305
Number of pages	9
Journal	Journal of Hepatology
Volume	57
Issue number	2
DOIs	https://doi.org/10.1016/j.jhep.2012.03.022
Publication status	Published - Aug 2012

Keywords

Adolescent
Adult
Aged
Carcinoma, Hepatocellular
Child
Child, Preschool
Female
Humans
Liver Neoplasms
Liver Transplantation
Lymphatic Metastasis
Male
Middle Aged
Neoplasm Invasiveness
Survival Rate

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10.1016/j.jhep.2012.03.022

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Mergental, H., Adam, R., Ericzon, B-G., Kalicinski, P., Mühlbacher, F., Höckerstedt, K., Klempnauer, J. L., Friman, S., Broelsch, C. E., Mantion, G., Fernandez-Sellez, C., van Hoek, B., Fangmann, J., Pirenne, J., Muiesan, P., Königsrainer, A., Mirza, D. F., Lerut, J., Detry, O., ... Porte, R. J. (2012). Liver transplantation for unresectable hepatocellular carcinoma in normal livers. Journal of Hepatology, 57(2), 297-305. https://doi.org/10.1016/j.jhep.2012.03.022

@article{6214c5a01ac548e2876a009a8c2bef2e,

title = "Liver transplantation for unresectable hepatocellular carcinoma in normal livers",

abstract = "BACKGROUND & AIMS: The role of liver transplantation in the treatment of hepatocellular carcinoma in livers without fibrosis/cirrhosis (NC-HCC) is unclear. We aimed to determine selection criteria for liver transplantation in patients with NC-HCC.METHODS: Using the European Liver Transplant Registry, we identified 105 patients who underwent liver transplantation for unresectable NC-HCC. Detailed information about patient, tumor characteristics, and survival was obtained from the transplant centers. Variables associated with survival were identified using univariate and multivariate statistical analyses.RESULTS: Liver transplantation was primary treatment in 62 patients and rescue therapy for intrahepatic recurrences after liver resection in 43. Median number of tumors was 3 (range 1-7) and median tumor size 8 cm (range 0.5-30). One- and 5-year overall and tumor-free survival rates were 84% and 49% and 76% and 43%, respectively. Macrovascular invasion (HR 2.55, 95% CI 1.34 to 4.86), lymph node involvement (HR 2.60, 95% CI 1.28 to 5.28), and time interval between liver resection and transplantation < 12 months (HR 2.12, 95% CI 0.96 to 4.67) were independently associated with survival. Five-year survival in patients without macrovascular invasion or lymph node involvement was 59% (95% CI 47-70%). Tumor size was not associated with survival.CONCLUSIONS: This is the largest reported series of patients transplanted for NC-HCC. Selection of patients without macrovascular invasion or lymph node involvement, or patients ≥ 12months after previous liver resection, can result in 5-year survival rates of 59%. In contrast to HCC in cirrhosis, tumor size is not a predictor of post-transplant survival in NC-HCC.",

keywords = "Adolescent, Adult, Aged, Carcinoma, Hepatocellular, Child, Child, Preschool, Female, Humans, Liver Neoplasms, Liver Transplantation, Lymphatic Metastasis, Male, Middle Aged, Neoplasm Invasiveness, Survival Rate",

author = "Hynek Mergental and Rene Adam and Bo-Goran Ericzon and Piotr Kalicinski and Ferninand M{\"u}hlbacher and Krister H{\"o}ckerstedt and Klempnauer, {J{\"u}rgen L} and Styrbj{\"o}rn Friman and Broelsch, {Christoph E} and Georges Mantion and Carlos Fernandez-Sellez and {van Hoek}, Bart and Josef Fangmann and Jacques Pirenne and Paolo Muiesan and Alfred K{\"o}nigsrainer and Mirza, {Darius F} and Jan Lerut and Olivier Detry and {Le Treut}, Yves-Ptrice and Vincenzo Mazzaferro and Florian L{\"o}he and Marina Berenguer and Pierre-Alain Clavien and Xavier Rogiers and Jacques Belghiti and Laslo K{\'o}bori and Patrizia Burra and Philippe Wolf and Wolfgang Schareck and Przemyslaw Pisarski and Aksel Foss and Franco Filipponi and Marek Krawczyk and Martin Wolff and Langrehr, {Jan M} and Keith Rolles and Neville Jamieson and Hop, {Wim C J} and Porte, {Robert J}",

year = "2012",

month = aug,

doi = "10.1016/j.jhep.2012.03.022",

language = "English",

volume = "57",

pages = "297--305",

journal = "Journal of Hepatology",

issn = "0168-8278",

publisher = "Elsevier",

number = "2",

}

Mergental, H, Adam, R, Ericzon, B-G, Kalicinski, P, Mühlbacher, F, Höckerstedt, K, Klempnauer, JL, Friman, S, Broelsch, CE, Mantion, G, Fernandez-Sellez, C, van Hoek, B, Fangmann, J, Pirenne, J, Muiesan, P, Königsrainer, A, Mirza, DF, Lerut, J, Detry, O, Le Treut, Y-P, Mazzaferro, V, Löhe, F, Berenguer, M, Clavien, P-A, Rogiers, X, Belghiti, J, Kóbori, L, Burra, P, Wolf, P, Schareck, W, Pisarski, P, Foss, A, Filipponi, F, Krawczyk, M, Wolff, M, Langrehr, JM, Rolles, K, Jamieson, N, Hop, WCJ & Porte, RJ 2012, 'Liver transplantation for unresectable hepatocellular carcinoma in normal livers', Journal of Hepatology, vol. 57, no. 2, pp. 297-305. https://doi.org/10.1016/j.jhep.2012.03.022

TY - JOUR

T1 - Liver transplantation for unresectable hepatocellular carcinoma in normal livers

AU - Mergental, Hynek

AU - Adam, Rene

AU - Ericzon, Bo-Goran

AU - Kalicinski, Piotr

AU - Mühlbacher, Ferninand

AU - Höckerstedt, Krister

AU - Klempnauer, Jürgen L

AU - Friman, Styrbjörn

AU - Broelsch, Christoph E

AU - Mantion, Georges

AU - Fernandez-Sellez, Carlos

AU - van Hoek, Bart

AU - Fangmann, Josef

AU - Pirenne, Jacques

AU - Muiesan, Paolo

AU - Königsrainer, Alfred

AU - Mirza, Darius F

AU - Lerut, Jan

AU - Detry, Olivier

AU - Le Treut, Yves-Ptrice

AU - Mazzaferro, Vincenzo

AU - Löhe, Florian

AU - Berenguer, Marina

AU - Clavien, Pierre-Alain

AU - Rogiers, Xavier

AU - Belghiti, Jacques

AU - Kóbori, Laslo

AU - Burra, Patrizia

AU - Wolf, Philippe

AU - Schareck, Wolfgang

AU - Pisarski, Przemyslaw

AU - Foss, Aksel

AU - Filipponi, Franco

AU - Krawczyk, Marek

AU - Wolff, Martin

AU - Langrehr, Jan M

AU - Rolles, Keith

AU - Jamieson, Neville

AU - Hop, Wim C J

AU - Porte, Robert J

PY - 2012/8

Y1 - 2012/8

N2 - BACKGROUND & AIMS: The role of liver transplantation in the treatment of hepatocellular carcinoma in livers without fibrosis/cirrhosis (NC-HCC) is unclear. We aimed to determine selection criteria for liver transplantation in patients with NC-HCC.METHODS: Using the European Liver Transplant Registry, we identified 105 patients who underwent liver transplantation for unresectable NC-HCC. Detailed information about patient, tumor characteristics, and survival was obtained from the transplant centers. Variables associated with survival were identified using univariate and multivariate statistical analyses.RESULTS: Liver transplantation was primary treatment in 62 patients and rescue therapy for intrahepatic recurrences after liver resection in 43. Median number of tumors was 3 (range 1-7) and median tumor size 8 cm (range 0.5-30). One- and 5-year overall and tumor-free survival rates were 84% and 49% and 76% and 43%, respectively. Macrovascular invasion (HR 2.55, 95% CI 1.34 to 4.86), lymph node involvement (HR 2.60, 95% CI 1.28 to 5.28), and time interval between liver resection and transplantation < 12 months (HR 2.12, 95% CI 0.96 to 4.67) were independently associated with survival. Five-year survival in patients without macrovascular invasion or lymph node involvement was 59% (95% CI 47-70%). Tumor size was not associated with survival.CONCLUSIONS: This is the largest reported series of patients transplanted for NC-HCC. Selection of patients without macrovascular invasion or lymph node involvement, or patients ≥ 12months after previous liver resection, can result in 5-year survival rates of 59%. In contrast to HCC in cirrhosis, tumor size is not a predictor of post-transplant survival in NC-HCC.

AB - BACKGROUND & AIMS: The role of liver transplantation in the treatment of hepatocellular carcinoma in livers without fibrosis/cirrhosis (NC-HCC) is unclear. We aimed to determine selection criteria for liver transplantation in patients with NC-HCC.METHODS: Using the European Liver Transplant Registry, we identified 105 patients who underwent liver transplantation for unresectable NC-HCC. Detailed information about patient, tumor characteristics, and survival was obtained from the transplant centers. Variables associated with survival were identified using univariate and multivariate statistical analyses.RESULTS: Liver transplantation was primary treatment in 62 patients and rescue therapy for intrahepatic recurrences after liver resection in 43. Median number of tumors was 3 (range 1-7) and median tumor size 8 cm (range 0.5-30). One- and 5-year overall and tumor-free survival rates were 84% and 49% and 76% and 43%, respectively. Macrovascular invasion (HR 2.55, 95% CI 1.34 to 4.86), lymph node involvement (HR 2.60, 95% CI 1.28 to 5.28), and time interval between liver resection and transplantation < 12 months (HR 2.12, 95% CI 0.96 to 4.67) were independently associated with survival. Five-year survival in patients without macrovascular invasion or lymph node involvement was 59% (95% CI 47-70%). Tumor size was not associated with survival.CONCLUSIONS: This is the largest reported series of patients transplanted for NC-HCC. Selection of patients without macrovascular invasion or lymph node involvement, or patients ≥ 12months after previous liver resection, can result in 5-year survival rates of 59%. In contrast to HCC in cirrhosis, tumor size is not a predictor of post-transplant survival in NC-HCC.

KW - Adolescent

KW - Adult

KW - Aged

KW - Carcinoma, Hepatocellular

KW - Child

KW - Child, Preschool

KW - Female

KW - Humans

KW - Liver Neoplasms

KW - Liver Transplantation

KW - Lymphatic Metastasis

KW - Male

KW - Middle Aged

KW - Neoplasm Invasiveness

KW - Survival Rate

U2 - 10.1016/j.jhep.2012.03.022

DO - 10.1016/j.jhep.2012.03.022

M3 - Article

C2 - 22521348

SN - 0168-8278

VL - 57

SP - 297

EP - 305

JO - Journal of Hepatology

JF - Journal of Hepatology

IS - 2

ER -

Liver transplantation for unresectable hepatocellular carcinoma in normal livers

Abstract

Keywords

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