Total Tumor Volume Predicts Recurrence of Hepatocellular Carcinoma after Liver Transplantation in Patients Beyond Milan or UCSF Criteria

• Published in: Transplantation proceedings Vol. 42; no. 10; pp. 4585 - 4592
• Main Authors: Macaron, C, Hanouneh, I.A, Lopez, R, Aucejo, F, Zein, N.N
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Inc 01.12.2010; Elsevier
• Subjects: Biological and medical sciences; Carcinoma, Hepatocellular - pathology; Carcinoma, Hepatocellular - surgery; Female; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Immunosuppressive Agents - administration & dosage; Liver Neoplasms - pathology; Liver Neoplasms - surgery; Liver Transplantation; Liver, biliary tract, pancreas, portal circulation, spleen; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Middle Aged; Proportional Hazards Models; Recurrence; Retrospective Studies; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Tissue, organ and graft immunology; Tumors; Human; Relapse; Digestive system; Liver; Prediction; Hepatic disease; Hepatocellular carcinoma; Patient; Malignant tumor; Homotransplantation; Medicine; Liver cancer; Treatment; Criterion; Volume; Surgery; Total; Digestive diseases; Graft; Predictive factor; Cancer; Liver transplantation
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2010.10.012

Abstract Background The aim of tumor-based selection criteria in patients with hepatocellular carcinoma (HCC) is to prevent orthotopic liver transplantation (OLT) in patients likely to experience recurrence and to maximize OLT opportunities for those with a high likelihood of cure. Objective Our aim was to assess total tumor volume (TTV) as a selection criterion for OLT in patients with HCC beyond Milan or University of California San Francisco criteria. Methods We identified patients who underwent OLT for HCC between 2002 and 2008. TTV was calculated as the sum of the volumes of all tumors on pretransplant imaging before any therapy [(4/3)πr3 , where r is the maximum radius of each HCC]. Univariable and multivariable Cox proportional hazards regression analysis was used to assess factors associated with recurrence of HCC. Results 107 patients were included in the study. The mean follow-up was 21 months (interqartile range, 11.8–32.5), during which 13 patients (12.1%) experienced recurrence of HCC. Twenty-nine patients (27.1%) had HCC beyond the Milan criteria. A TTV cutoff value of 33.5 cm3 was chosen on the basis of the risk of recurrence by using a receiver operating characteristic curve. Patients beyond the Milan criteria with TTV <33.5 experienced less recurrence (13.3% vs 42.8%; P < .001) and higher survival (13.3% vs 57.1%; P = .006) than those who were beyond the Milan criteria with TTV ≥33.5. Similarly, TTV predicted HCC recurrence and survival in those beyond the UCSF criteria. Conclusion TTV is useful in identifying patients at risk of tumor recurrence and poor survival among those with tumor burden beyond traditional criteria, and it may improve the selection of OLT candidates.