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Published on: September 30, 2021
Liver transplantation for hepatocellular carcinoma: expanding special priority to include stage III disease
Jeremy Goodman1, Sean C Glasgow, Mark Schnitzler
1Section of Abdominal Transplantation, Department of Surgery, Washington University, St Louis, MO, USA.
Insights
Liver transplant patients with stage III hepatocellular carcinoma (HCC) show survival rates comparable to controls. This suggests stage III HCC patients may benefit from liver transplantation, warranting consideration for exception points.
Area of Science:
- Hepatobiliary Surgery
- Transplant Immunology
- Surgical Oncology
Background:
- Hepatocellular carcinoma (HCC) is a leading cause of liver transplantation.
- Prognosis for HCC patients undergoing liver transplantation varies significantly by disease stage.
Purpose of the Study:
- To evaluate long-term survival outcomes for liver transplant recipients with stage III hepatocellular carcinoma (HCC).
- To compare survival rates of stage III HCC patients with matched controls and patients with other HCC stages.
Main Methods:
- Retrospective analysis of prospectively collected data from a university hospital.
- Comparison of 1-, 3-, and 5-year survival rates between 51 HCC patients and 153 matched non-HCC controls.
- Matching criteria included year of transplantation, age, sex, and underlying liver disease.
Main Results:
- Overall 5-year survival was 48% for HCC patients versus 65% for controls (P=.07).
- When stages I-III HCC were combined, 5-year survival was comparable to controls (59% vs 63%; P=.96).
- Stage III HCC patients demonstrated survival comparable to matched controls (65% vs 59%; P=.44).
Conclusions:
- Long-term survival after liver transplantation is comparable for patients with stages I-III HCC and matched controls.
- Only patients with stage IV HCC experience significantly poorer survival outcomes.
- Consideration should be given to granting exception points for liver transplantation eligibility to patients with stage III HCC.
Hypothesis:
After liver transplantation, patients with stage III hepatocellular carcinoma (HCC) experience survivals similar to those of patients with less advanced disease and of matched control subjects.
Design:
Retrospective review of prospectively collected database.
Setting:
University hospital.
Patients:
Fifty-one adults with HCC and 153 matched adults without HCC who underwent orthotopic liver transplantation.
Main Outcome Measures:
One-, 3-, and 5-year survivals for all groups. After matching for year of transplantation, age, sex, and underlying liver disease, long-term survival was compared between groups. Rates of recurrence were also measured in the HCC groups.
Results:
From August 1, 1985, to February 28, 2002, we performed 635 adult liver transplantations, including 51 (8%) in patients with HCC. One hundred fifty-one patients without HCC who underwent transplantation were selected as controls. Patient demographic features were similar between case-control groups. The overall 5-year survival trend was worse for patients with HCC vs their matched controls (48% vs 65%; P = .07); however, this survival disadvantage was eliminated when patients with stages I through III HCC were combined and compared with their matched controls (59% vs 63%; P = .96). Survival of patients with stage III disease was comparable to that of matched controls (65% vs 59%; P = .44).
Conclusions:
For patients with stages I through III disease, long-term survival is comparable to that of matched controls, and only patients with stage IV disease experience poorer survival. Consideration should be given to granting exception points to patients with stage III disease.
