[Multivariate analysis of recurrence of hepatocellular carcinoma after liver transplantation]

To explore the prognostic factors for the recurrence of hepatocellular carcinoma (HCC) after liver transplantation (LT) through analyzing the clinical and imaging characteristics of HCC.

The preoperative data of 230 consecutive HCC cases undergoing LT were retrospectively collected from our hospital from October 2003 to July 2009. There were 210 males and 20 females with a median age of 50 years. Their survival rates were calculated by Kaplan-Meier method. The disease-free survival curves of different prognostic factors were plotted by Kaplan-Meier method. The prognostic factors were analyzed by Log-rank test and Forward Conditional Cox regression respectively to yield the related risk factors and independent risk factors for the recurrence of HCC after LT.

The median follow-up period was 29 months (range: 3 - 68). The outcomes included recurrence (n = 77), no recurrence (n = 153) and mortality (n = 63). Their 1-, 3- and 5-year cumulative survival rates and cumulative disease-free survival rates were 84%, 75%, 69% and 73%, 65%, 63% respectively. Univariate analysis with Log-rank test revealed that the following prognostic factors were significant (P < 0.05): age < 50 years, exceeding Milan-criteria, TNM stages of II-III, number of tumor ≥ 2, the diameter of the largest viable tumor > 5 cm, the post-intervention diameter of viable tumor ≥ 30% of entire tumor diameter, tumor distribution > 1 lobe, indistinct boundary of tumor, histological differentiation, serum α-fetoprotein level > 400 ng/ml, the sum of viable tumor diameters ≥ 7.7 cm and intrahepatic portal venous thrombosis. Multivariate analysis with a forward conditional Cox hazard model revealed that the following prognostic factors were independently statistically significant (P < 0.05) : histological differentiation, serum α-fetoprotein level > 400 ng/ml, the sum of viable tumor diameters ≥ 7.7 cm and intrahepatic portal venous thrombosis.

Poor histological differentiation, serum α-fetoprotein level > 400 ng/ml, the sum of viable tumor diameters ≥ 7.7 cm and intrahepatic portal venous thrombosis are significant risk factors. Preoperative aggressive interventional therapy may prolong the disease-free survival period of HCC after LT.