Hepato-gastroenterology · 2013
Factors affecting recurrence and survival after living donor liver transplantation for hepatocellular carcinoma.
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Abdel-Wahab Mohammed, Sultan Ahmad M, Fathy Omar M, Salah Tarek, Elshobary Mohammed M, Elghawalby Nabieh A, Yassen Amr M, Elsarraf Walid M R, Elsaadany Mohammed F, Zalatah Khaled
Аннотация
BACKGROUND/AIMS: HCC is a leading cause of cancer-related deaths worldwide. The main etiological factor in Egypt is HCV infection. Lack of cadaveric transplantation in Egypt makes LDLT the only available option for liver transplantation for HCC patients with advanced cirrhosis and/or non-resectable tumors.
METHODOLOGY: Between January 2004 and April 2012, 170 patients underwent LDLT at the Liver Transplantation Unit, Mansoura University, and 52 (30.6%) were shown to have HCC by pathological examination. Patient demographics, preoperative interventions and pathological findings were evaluated for their influence on recurrence and survival. Patients were followed-up with abdominal sonography and AFP every 3 months and CT scans every 6 months. Median follow-up was 22.9 months.
RESULTS: The main cause of underlying cirrhosis was HCV (96.2%). One or more different pre-transplant treatments of HCC were performed in 14 (27.4%) patients. The median total size was 4cm (0.8-15.5). Microvascular invasion was detected in 16 (31.4%) patients; 16 patients proved to have tumors beyond the Milan criteria. Pre-transplantation AFP more than 200ng/mL, total tumor size more than 8cm and microvascular invasion influenced recurrence rate on univariate analysis. Multivariate analysis identified AFP (p = 0.016) as independent factor for recurrence. Survival was significantly affected by AFP (p = 0.003) and microvascular invasion (p = 0.003).
CONCLUSIONS: LDLT is a feasible option for patients with HCC on top of cirrhosis with good survival and recurrence-free survival rates.
METHODOLOGY: Between January 2004 and April 2012, 170 patients underwent LDLT at the Liver Transplantation Unit, Mansoura University, and 52 (30.6%) were shown to have HCC by pathological examination. Patient demographics, preoperative interventions and pathological findings were evaluated for their influence on recurrence and survival. Patients were followed-up with abdominal sonography and AFP every 3 months and CT scans every 6 months. Median follow-up was 22.9 months.
RESULTS: The main cause of underlying cirrhosis was HCV (96.2%). One or more different pre-transplant treatments of HCC were performed in 14 (27.4%) patients. The median total size was 4cm (0.8-15.5). Microvascular invasion was detected in 16 (31.4%) patients; 16 patients proved to have tumors beyond the Milan criteria. Pre-transplantation AFP more than 200ng/mL, total tumor size more than 8cm and microvascular invasion influenced recurrence rate on univariate analysis. Multivariate analysis identified AFP (p = 0.016) as independent factor for recurrence. Survival was significantly affected by AFP (p = 0.003) and microvascular invasion (p = 0.003).
CONCLUSIONS: LDLT is a feasible option for patients with HCC on top of cirrhosis with good survival and recurrence-free survival rates.
Предметные рубрики MeSH
AdultCarcinoma, HepatocellularChi-Square DistributionDisease-Free SurvivalEgyptFemaleHumansKaplan-Meier EstimateLiver NeoplasmsLiver TransplantationLiving DonorsLogistic ModelsMaleMiddle AgedMultivariate AnalysisNeoplasm InvasivenessNeoplasm Recurrence, LocalPatient SelectionRisk FactorsSurvival RateTime FactorsTomography, X-Ray ComputedTreatment Outcomealpha-Fetoproteins