Recurrence patterns of hepatocellular and fibrolamellar carcinoma after liver transplantation

Purpose: Tumor recurrence is the major limitation of long-term survival aft er liver transplantation for hepatocellular carcinoma (HCC) or fibrolamella r carcinoma (FLC). Understanding tumor-biologic characteristics is importan t for selection of patients and for development of adjuvant therapeutic str ategies. Patients and Methods: The study included 69 patients who underwent potentia lly curative liver transplantation for HCC/FLC and survived for more than 1 50 days; minimum follow-up was 33 months. Frequency, localization, and timi ng of recurrence were analyzed and compared with primary tumor and patient characteristics. Results: Tumor recurrence was observed in 39 patients at 67 locations. Hema togenous spread was the major route of tumor recurrence (87%), and the most frequent sites were the liver (62%), lung (56%), and bone (18%). Parameter s associated with recurrence were absence of cirrhosis, tumor size greater than 5 cm, more than five nodules, vascular infiltration, and International Union Against Cancer (UICC) stage IVA. Selective intrahepatic recurrence w as found in nine patients (23%); it was associated with highly differentiat ed tumors, lack of vascular infiltration, and male sex. Recurrence at multi ple sites was found predominantly in young patients (less than or equal to 40 years) and for multicentric (> 5) primary tumors. Recurrences were obser ved within a wide time range after transplantation (43 to 3,204 days; media n, 441 days); late recurrences (> 1,000 days, n = 8) were associated with h ighly differentiated or fibrolamellar tumors and row UICC stages. Surgical treatment was the only therapeutic option associated with prolonged surviva l after recurrence. Conclusion: In transplant recipients, hepatocellular carcinomas vary consid erably in their pattern and kinetics of metastases. Tumor cells may persist in a dormant state for long time periods before giving rise to clinical me tastases, Surgical treatment of recurrence should be considered whenever po ssible. J Clin Oncol 17:324-331. (C) 1999 by American Society of Clinical Oncology.