|
|
Back to 2015 Annual Meeting Program
When Should WE Propose Liver Transplantation After Liver Resection for Hepatocellular Carcinoma?
Ecoline Tribillon*1, Louise Barbier1, Olivier Scatton2, Claire Goumard2, Sabine Irtan1, Fabiano Perdigao-Cotta2, Francois Durand1, Valerie Paradis1, Jacques Belghiti1, Olivier Soubrane1
1Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France; 2Digestive, Hepato-Biliary and Pancreatic Surgery Department, Pitié Salpêtrière Hospital, Paris, France
Introduction:
Liver resection (LR) can be used as a selection tool for the management of early hepatocellular carcinoma (HCC). The best timing to propose liver transplantation (LT) after initial LR is still debated. The aim of this study was to compare survival outcomes in patients listed for LT before or at HCC recurrence.
Methods:
All patients who underwent LT following LR for HCC in 2 French centers from January 1998 to June 2013 were included and compared according to their status at the time of listing for LT: before or at recurrence of HCC. Primary end-point was survival since LT.
Results:
One hundred and six patients underwent LT following LR for HCC. Forty patients were listed at recurrence, and 66 patients before recurrence, among whom 20 had HCC recurrence while on the waiting list. Regarding initial HCC resection, preoperative α-fetoprotein levels were not different between groups. Pathological characteristics of the resected specimen were not different regarding number of tumors, total diameter of the tumors, differentiation, presence of a capsule, satellite nodules, vascular invasion, R1 resections, and Milan criteria. However, the mean diameter of the largest tumor was higher in the group listed at recurrence (48 ± 38 versus 32 ± 18 mm, p=0.024). Regarding LT, pathological examination of the explant found HCC nodules in 30 (46%) patients listed before recurrence and 32 (80%) listed at recurrence (p<0.001). After a mean follow-up of 68 ± 52 months since LT, the 5-year disease-free survival rate was significantly higher in the group listed before recurrence compared to the group listed at recurrence (respectively 80% versus 60%, p=0.008). Furthermore, 5-year overall survival rate since LT was also significantly increased in the group listed before recurrence compared to the group listed at recurrence (respectively 86% versus 63%, p=0.003).
In a multivariate analysis, the only independent prognostic factor for recurrence-free survival since LT was the listing for LT before recurrence of HCC (p=0.038, OR=2.5 [1.1-5.8]).
Conclusion:
This study suggests that patients who had resection of HCC should be listed for LT before recurrence. This strategy was associated with greater overall and disease-free survivals.
Back to 2015 Annual Meeting Program
|
