Analysis of Risk Factors for Recurrence of Hepatocellular Carcinoma after Liver Transplantation_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHANG Rongsheng ,  WANG Xuan , ZHANG Bin , LI Zengcai , JIANG Tao , LU Lei , ZHANG Donghua.

Department of Oncological Surgery, Center of Liver Transplantation of The 81st Hospital of PLA, Nanjing 210002, Jiangsu Province, China;

Corresponding author：

WANG Xuan, Email: wangxucn2002@hotmail.com

Keywords：

Hepatocellular carcinoma; Liver transplantation; Recurrence; Alpha fetoprotein; Tumor size

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ObjectiveTo determine the risk factors for recurrence of hepatocellular carcinoma (HCC) after orthotopic liver transplantation (OLT). MethodsThe clinical data from seventysix consecutive HCC patients who underwent OLT were retrospectively analyzed. The patients were divided into nonrecurrence group (n=53) and recurrence group (n=23) based on recurrence, and the characteristics of tumor recurrence were analyzed. ResultsThe overall recurrence rate of tumor was 30.3% (23/76). By univariate analysis, gender (P=0.449), age (P=0.091), received preoperative therapy or not (P=0.958), tumor numbers (P=0.212), and HBV/HCV infection (P=0.220) were not closely related with tumor recurrence, while the integrality of tumor capsule (P=0.009), tumor stage (P=0.002), tumor diameter (P lt;0.001), vascular invasion (P lt;0.001), and AFP level before transplantation (P=0.044) were significantly related with tumor recurrence. Furthermore, the oneyear recurrence rate of tumor was higher in patients whose AFP level returned to normal within two months after transplantation (P lt;0.001) and tumor diameter was less than 5.0 cm (P=0.001). Multivariate analysis revealed that tumor diameter (P=0.001, OR=6.456, 95%CI: 2.356-17.680), vascular invasion (P=0.030, OR=10.653, 95%CI: 1.248-90.910), and AFP level before transplantation (P=0.017, OR=2.601, 95%CI: 2.196-5.658) were independent risk factors for tumor recurrence. ConclusionMore attentions shall be paid to these patients with tumor diameter gt;5.0 cm, vascular invasion, and AFP level before transplantation ≥400 μg/L, in particular AFP level is beyond normal within two months after transplantation, and antitumor therapy shall be given as soon as possible.

Citation： ZHANG Rongsheng,WANG Xuan,ZHANG Bin,LI Zengcai,JIANG Tao,LU Lei,ZHANG Donghua.. Analysis of Risk Factors for Recurrence of Hepatocellular Carcinoma after Liver Transplantation. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2011, 18(1): 29-32. doi: Copy

1.	Kosola S, Lauronen J, Sairanen H, et al. High survival rates after liver transplantation for hepatoblastoma and hepatocellular carcinoma [J]. Pediatr Transplant, 2010, 14(5): 646650.
2.	Coelho GR, Vasconcelos KF, Vasconcelos JB, et al. Orthotopic liver transplantation for hepatocellular carcinoma: one center’s experience in the Northeast of Brazil [J]. Transplant Proc, 2009, 41(5): 17401742.
3.	李波, 严律南, 袁丁, 等. 肝切除术后复发性肝癌的肝脏移植 [J]. 中国普外基础与临床杂志, 2009, 16(3): 191194.
4.	陈刚, 朱新锋, 刘其雨, 等. 存在大血管侵犯的肝癌患者的肝移植（附8例报道） [J]. 中国普外基础与临床杂志, 2008, 15(7): 484486.
5.	郑树森, 吴健. 肝移植治疗原发性肝癌的价值 [J]. 中国医学科学院学报, 2008, 30(4): 366370.
6.	郑树森, 陈峻, 王伟林, 等. 肝细胞癌肝移植术后复发和转移的研究: 单中心经验 [J]. 中华外科杂志, 2008, 46(21): 16091613.
7.	Mazzaferro V, Regalia E, Doci R. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis [J]. N Engl J Med, 1996, 34(11): 693699.
8.	Regalia E, Coppa J, Pulvirenti A, et al. Liver transplantation for small hepatocellular carcinoma in cirrhosis: analysis of our experience [J]. Transplant Proc, 2001, 33(12): 14421444.
9.	Toso C, Trotter J, Wei A, et al. Total tumor volume predicts risk of recurrence following liver transplantation in patients with hepatocellular carcinoma [J]. Liver Transpl, 2008, 14(8): 11071115.
10.	吕波, 文天夫. 肝癌肝移植及肝癌肝切除术后复发特点的比较 [J]. 中国普外基础与临床杂志, 2008, 15(3): 166170.
11.	Yao FY, Ferrell L, Bass NM, et al. Liver transplantation for hepatocellular carcinoma: comparison of the proposed UCSF criteria with the Milan criteria and the Pittsburgh modified TNM criteria [J]. Liver Transpl, 2002, 8(9): 765774.
12.	樊嘉, 周俭, 徐泱, 等. 肝癌肝移植适应证的选择: 上海复旦标准 [J]. 中华医学杂志, 2006, 86(16): 12271231.
13.	Iwatsuki S, Dvorchik I, Marsh JW, et al. Liver transplantation for hepatocellular carcinoma: a proposal of a prognostic scoring system [J]. J Am Coll Surg, 2000, 191(4): 389394.
14.	吴志全, 樊嘉, 邱双健, 等. 肝癌肝移植病肝改良切除 [J]. 中华肝胆外科杂志, 2005, 11(11): 782783.
15.	McHugh PP, Gilbert J, Vera S, et al. αfetoprotein and tumour size are associated with microvascular invasion in explanted livers of patients undergoing transplantation with hepatocellular carcinoma [J]. HPB (Oxford), 2010, 12(1): 5661.
16.	Esnaola NF, Lauwers GY, Mirza NQ, et al. Predictors of microvascular invasion in patients with hepatocellular carcinoma who are candidates for orthotopic liver transplantation [J]. J Gastrointest Surg, 2002, 6(2): 224232.
17.	贺轶锋, 樊嘉, 周俭, 等. 影响肝癌肝移植预后的高危因素分析及诊治经验 [J]. 中华医学杂志, 2006, 86(18): 12321235.
18.	Yao FY, Ferrell L, Bass NM, et al. Liver transplantation for hepatocelllular carcinoma: expansion of tumour size limits dos not adversely impact survival [J]. Hepatology, 2001, 33(6): 13941403.
19.	李耀锋, 周丁华. AFP和AFU预测原发性肝癌肝移植术后复发的价值 [J]. 中国现代普通外科杂志, 2009， 12(10): 866868, 878.

1. Kosola S, Lauronen J, Sairanen H, et al. High survival rates after liver transplantation for hepatoblastoma and hepatocellular carcinoma [J]. Pediatr Transplant, 2010, 14(5): 646650.
2. Coelho GR, Vasconcelos KF, Vasconcelos JB, et al. Orthotopic liver transplantation for hepatocellular carcinoma: one center’s experience in the Northeast of Brazil [J]. Transplant Proc, 2009, 41(5): 17401742.
3. 李波, 严律南, 袁丁, 等. 肝切除术后复发性肝癌的肝脏移植 [J]. 中国普外基础与临床杂志, 2009, 16(3): 191194.
4. 陈刚, 朱新锋, 刘其雨, 等. 存在大血管侵犯的肝癌患者的肝移植（附8例报道） [J]. 中国普外基础与临床杂志, 2008, 15(7): 484486.
5. 郑树森, 吴健. 肝移植治疗原发性肝癌的价值 [J]. 中国医学科学院学报, 2008, 30(4): 366370.
6. 郑树森, 陈峻, 王伟林, 等. 肝细胞癌肝移植术后复发和转移的研究: 单中心经验 [J]. 中华外科杂志, 2008, 46(21): 16091613.
7. Mazzaferro V, Regalia E, Doci R. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis [J]. N Engl J Med, 1996, 34(11): 693699.
8. Regalia E, Coppa J, Pulvirenti A, et al. Liver transplantation for small hepatocellular carcinoma in cirrhosis: analysis of our experience [J]. Transplant Proc, 2001, 33(12): 14421444.
9. Toso C, Trotter J, Wei A, et al. Total tumor volume predicts risk of recurrence following liver transplantation in patients with hepatocellular carcinoma [J]. Liver Transpl, 2008, 14(8): 11071115.
10. 吕波, 文天夫. 肝癌肝移植及肝癌肝切除术后复发特点的比较 [J]. 中国普外基础与临床杂志, 2008, 15(3): 166170.
11. Yao FY, Ferrell L, Bass NM, et al. Liver transplantation for hepatocellular carcinoma: comparison of the proposed UCSF criteria with the Milan criteria and the Pittsburgh modified TNM criteria [J]. Liver Transpl, 2002, 8(9): 765774.
12. 樊嘉, 周俭, 徐泱, 等. 肝癌肝移植适应证的选择: 上海复旦标准 [J]. 中华医学杂志, 2006, 86(16): 12271231.
13. Iwatsuki S, Dvorchik I, Marsh JW, et al. Liver transplantation for hepatocellular carcinoma: a proposal of a prognostic scoring system [J]. J Am Coll Surg, 2000, 191(4): 389394.
14. 吴志全, 樊嘉, 邱双健, 等. 肝癌肝移植病肝改良切除 [J]. 中华肝胆外科杂志, 2005, 11(11): 782783.
15. McHugh PP, Gilbert J, Vera S, et al. αfetoprotein and tumour size are associated with microvascular invasion in explanted livers of patients undergoing transplantation with hepatocellular carcinoma [J]. HPB (Oxford), 2010, 12(1): 5661.
16. Esnaola NF, Lauwers GY, Mirza NQ, et al. Predictors of microvascular invasion in patients with hepatocellular carcinoma who are candidates for orthotopic liver transplantation [J]. J Gastrointest Surg, 2002, 6(2): 224232.
17. 贺轶锋, 樊嘉, 周俭, 等. 影响肝癌肝移植预后的高危因素分析及诊治经验 [J]. 中华医学杂志, 2006, 86(18): 12321235.
18. Yao FY, Ferrell L, Bass NM, et al. Liver transplantation for hepatocelllular carcinoma: expansion of tumour size limits dos not adversely impact survival [J]. Hepatology, 2001, 33(6): 13941403.
19. 李耀锋, 周丁华. AFP和AFU预测原发性肝癌肝移植术后复发的价值 [J]. 中国现代普通外科杂志, 2009， 12(10): 866868, 878.

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Analysis of Risk Factors for Recurrence of Hepatocellular Carcinoma after Liver Transplantation

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