Tumor recurrence after oLTX

  • Th. Gruenberger
  • Th. Windhager
  • M. Gnant
  • M. Mittlböck
  • R. Steininger
  • F. Herbst
  • F. Muehlbacher
Conference paper

Abstract

Although early survival following transplantation for primary hepatic cancer is excellent, previously reported high recurrence rates have generally discouraged liver replacement for this condition. The aim of this retrospective analysis was to examine the influence of risk factors on the development of early tumor recurrence. Between December 1982 and June 1995, 480 liver transplantations were performed at a single institution. Out of these, 103 patients had unresectable primary hepatic cancer (88 hepatocellular cancer; HCCA; 20%) and 15 had cholangiocellular cancer (CHCA; 4%). The influence of the following tumor-associated risk factors was assessed: tumor size, tumor distribution within the liver, grading, pseudocapsular formation, vascular invasion, lymph node metastasis, and cirrhotic alteration. The diagnosis of tumor recurrence was made using various radiological imaging techniques, reelavation of serum alphafetoprotein, or autopsy. For patient survival and disease-free period, data analysis was performed by the method of Kaplan-Meier. The Cox model was used for multivariate analysis; a P-value of less than 0.05 was considered to be significant. The mean age of the 103 patients was 54 years (range 15–63 a). There were 22 female and 81 male patients. The follow-up period ranged between 4 and 108 months. Twenty-nine patients (50%) died during the follow-up period due to recurrence of disease. The survival rates of the 88 patients with HCCA were 57%, 34%, and 26% at 1, 3, and 5 years, respectively, after orthotopic liver transplantation (oLTX; follow-up 36 month). Of the 15 pts with CHCA the rates were 53%, 33%, and 33%, respectively, with a median follow-up of 60 months. The influence of the risk factors studied showed a significantly longer disease-free period for the following tumorcharacteristics: grading below or equal 2 (P = 0.009) and absence of vascular invasion (P = 0.04). Regarding a median survival rate of 2–4 months for patients with unresectable malignant liver tumors, these results confirmed the indication for oLTX, especially if the patient does not compete with someone on the waiting list for benign liver disease.

Key words

Liver transplantation Primary hepatic cancer Outcome 

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References

  1. 1.
    Iwatsuki S, Shaw BW, Starzl TE, et al (1985) Role of liver transplantation in cancer therapy. Ann Surg 202: 401–407PubMedCrossRefGoogle Scholar
  2. 2.
    Iwatsuki S, Starzl TE, Sheahan DG, et al (1991) Hepatic resection versus transplantation for hepatocellular carcinoma. Ann Surg 214: 221–229PubMedCrossRefGoogle Scholar
  3. 3.
    Ringe B, Wittekind C, Bechstein WO, et al (1989) The role of liver transplan- tation in hepatobiliary malignancy. A retrospective analysis of 95 patients with particular regard to tumor stage and recurrence. Ann Surg 209: 88–98PubMedCrossRefGoogle Scholar
  4. 4.
    Yokojama I, Todo S, Iwatsuki S, et al (1990) Liver transplantation in the treatment of primary liver cancer. Hepatogastroenterology 37: 188–193Google Scholar
  5. 5.
    Yokojama I, Sheahan DG, Carr B, et al (1991) Clinicopathologic factors affecting patient survival and tumor recurrence after orthotopic liver transplantation for hepatocellular carcinoma. Transplant Proc 223: 2194–2196Google Scholar
  6. 6.
    McPeake JR, O’Grady JG, Zaman S, et al (1993) Liver transplantation for primary hepatocellular carcinoma: tumor size and number determine outcome. J Hepatol 18: 226–234PubMedCrossRefGoogle Scholar
  7. 7.
    Bismuth H, Chiche L, Adam R, et al (1993) Liver resection versus transplantation for hepatocellular carcinoma in cirrhotic patients. Ann Surg 218: 145151Google Scholar
  8. 8.
    Chergui D, Piedbois P, Pierga JY, et al (1994) Multimodal adjuvant treatment and liver transplantation for advanced hepatocellular carcinoma. Cancer 73: 2721–2726CrossRefGoogle Scholar
  9. 9.
    Stone MJ, Klintmalm GBG, Polter D, et al (1993) Neoadjuvant chemotherapy and liver transplantation for hepatocellular carcinoma. Gastroenterology 104: 196–202PubMedGoogle Scholar
  10. 10.
    Olthoff KM, Rosove MH, Shackleton CR, et al (1995) Adjuvant chemotherapy improves survival after liver transplantation for hepatocellular carcinoma. Ann Surg 221: 734–743PubMedCrossRefGoogle Scholar
  11. 11.
    Ringe B, Pichlmayr R, Wittekind C, et al (1991) Surgical treatment of hepatocellular carcinoma: experience with liver resection and transplantation in 198 patients. World J Surg 15: 270–285PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1996

Authors and Affiliations

  • Th. Gruenberger
    • 1
    • 2
  • Th. Windhager
    • 1
  • M. Gnant
    • 1
  • M. Mittlböck
    • 1
  • R. Steininger
    • 1
  • F. Herbst
    • 1
  • F. Muehlbacher
    • 1
  1. 1.Department of Transplantation SurgeryUniversity of ViennaAustria
  2. 2.Department of General SurgeryUniversity of ViennaViennaAustria

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