Liver Transplantation for Intermediate-Stage Hepatocellular Carcinoma

Transarterial chemoembolization is the standard treatment for patients with intermediate-stage hepatocellular carcinoma (HCC) according to the Barcelona Clinic Liver Cancer staging system. However, in Japan, not a few patients with intermediate-stage HCC undergo liver transplantation (LT). The present study investigated characteristics and outcomes of LT for intermediate-stage HCC. Between February 1999 and November 2016, a total of 226 patients underwent LT for HCC at our institute. Among these, 56 patients showed intermediate-stage HCC (24.8%). We examined overall survival and recurrence rate after LT according to our extended criteria (maximum size ≤5 cm, number ≤10, des-gamma-carboxy prothrombin ≤400 mAU/mL) and pretreatment. One-, 3-, and 5-year overall survival and recurrence rates of LT for intermediate-stage HCC were 88/64/58% and 22/34/44%, respectively. One-, 3-, and 5-year overall survival and recurrence rates in patients within (n = 35) the criteria (94/80/80% and 9/15/22%, respectively) were significantly better than those in patients beyond (n = 21) the criteria (81/43/29%, p = 0.002 and 39/41/66%, p = 0.001, respectively). Forty-nine cases (88%) had a history of pretreatment. In patients within our extended criteria, overall survival and recurrence rates did not differ significantly between patients with (n = 31) and without (n = 4) pretreatment. In conclusion, outcomes after LT for intermediate-stage HCC are more favorable if patients meet our extended criteria.