LIVER-TRANSPLANTATION FOR HEPATOCELLULAR-CARCINOMA - A REGISTRY REPORT OF THE IMPACT OF TUMOR CHARACTERISTICS ON OUTCOME

Objective The objective of this study from the International Registry of Hepatic Tumors in Liver Transplantation is to analyze the impact of tumor characteristics on tumor recurrence and patient survival. Summa ry Background Data Many attempts have been made to identify patients w ith hepatocellular carcinoma who can be treated successfully with live r transplantation. Studies presented to date lack enough patients to m ake reported findings universally accepted. In lieu of a prospective, randomized multicenter trial, in 1992 an international Registry of Hep atic Tumors in Liver Transplantation was established to collect data o n these patients, their tumors, and their treatment. Methods The regis try mails out new patient registration forms and patient follow-up for ms twice yearly to all known liver trans plant programs. Fifty-three p rograms in 21 countries have supplied information on 553 patients with tumors. Four hundred ten patients had hepatocellular carcinoma (HCC), and 12 had the fibrolamellar variant of HCC (FLL-HCC). These 422 pati ents were investigated for this study. One hundred sixty-nine of these (40.0%) were classified as ''incidental tumors.'' For the remaining p atients, the tumor was known before the transplant. Twenty-six and eig ht tenths percent of the patients had a history of hepatitis B and 32. 7% had a history of hepatitis C. Results One hundred ninety patients ( 46.7%) have died, 99 free of tumor and 91 with tumor. Death was tumor related in 90 patients. Of the 232 patients now living, 215 are free o f tumor and 17 have tumor. The most common sites for recurrence are th e transplanted liver (41.7%) and the lungs (28.7%). The overall patien t survival was 72.2% at 1 year, 63.4% at 2 years, 47.4% at 4 years, an d 44.4% at 5 years. Using univariate analysis, incidental tumors (p = 0.3107), FLL-HCC (p = 0.0704), multifocal tumor (p = 0.5464), and bilo bar tumor (p = 0.1024) were not found to have an influence on patient survival. Four factors, tumor size greater than 5 cm (p = 0.0221), vas cular invasion (p = 0.0005), positive nodes (p = 0.0014), and histolog ic grade (p = 0.0001) had a profound impact on patient survival. Using Cox multiple regression analysis, only histologic grade had a negativ e impact on overall patient survival (p = 0.0009) acid for patients wi th known tumors (p = 0.0003). For incidental tumors, patient survival was negatively influenced by multifocality (p = 0.0021) and an age old er than 60 years (p = 0.0008). Tumor histologic grade (p = 0.0134) and size (>5 cm) (p = 0.0133) were significantly linked to recurrence-fre e patient survival. Conclusions This analysis has documented three tum or characteristics that strongly impact patient survival after transpl antation for HCC. In addition to tumor size greater than 5 cm and the presence of vascular invasion (which confirm several, single-center st udies), this registry notes that a poorly differentiated HCC may be a contraindication for transplantation, A liver tumor's histologic grade may be important information to have when these patients are consider ed for liver transplantation.