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

The precise staging of hepatocellular carcinoma (HCC) based on the size and number of lesions that predict recurrence after orthotopic liver transplan tation (OLT) has not been clearly established. We therefore analyzed the ou tcome of 70 consecutive patients with cirrhosis and HCC who underwent OLT o ver a 12-year period at our institution. Pathologic tumor staging of the ex planted liver was based on the American Tumor Study Group modified Tumor-No de-Metastases (TNM) Staging Classification. Tumor recurrence occurred in 11 .4% of patients after OLT. The Kaplan-Meier survival rates at 1 and 5 years were 91.3% and 72.4%, respectively, for patients with pT1 or pT2 HCC; and 82.4% and 74.1%, respectively, for pT3 tumors (P =.87). Patients with pT4 t umors, however, had a significantly worse 1-year survival of 33.3% (P =.000 1). An alpha -fetoprotein (AFP) level > 1,000 ng/mL, total tumor diameter > 8 cm, age greater than or equal to 55 years and poorly differentiated hist ologic grade were also significant predictors for reduced survival in univa riate analysis. Only pT4 stage and total tumor diameter remained statistica lly significant in multivariate analysis. Patients with HCC meeting the fol lowing criteria: solitary tumor less than or equal to 6.5 cm, or less than or equal to 3 nodules with the largest lesion less than or equal to 4.5 cm and total tumor diameter less than or equal to 8 cm, had survival rates of 90% and 75.2%, at 1 and 5 years, respectively, after OLT versus a 50% 1-yea r survival for patients with tumors exceeding these limits (P = .0005). We conclude that the current criteria for OLT based on tumor size may be modes tly expanded while still preserving excellent survival after OLT.