High Risk of Salvage Transplant Failure Post Liver Resection
Microscopic vascular invasion, nodules, tumor size, liver cirrhosis predict nontransplantability
FRIDAY, Sept. 30 (HealthDay News) -- Initial liver resection (LR) in hepatocellular carcinoma (HCC) within Milan criteria (MC) is a valid treatment for patients with good liver function who develop recurrence within MC, but salvage transplantation (ST) has a high rate of failure for those with recurrence beyond MC, according to a study published online Sept. 19 in Hepatology.
David Fuks, M.D., from the Beaujon Hospital in Paris, and colleagues investigated which patients might benefit from LR for HCC followed by ST in case of recurrence. LR was the primary therapy for 138 candidates with good liver function (LR group), and 191 candidates were listed to receive LT first (LT group). Resected patients who developed recurrence beyond MC were identified by uni- and multivariate analysis.
The investigators found that the five-year overall and disease-free survival outcomes did not differ significantly between the two groups. Among the LR group, 20 patients underwent LT before recurrence and 39 had ST. Of the patients with recurrence, 51 did not receive transplants, including 21 patients within MC who were excluded for acquired comorbidities, advanced age, or refusal, and 30 patients with recurrence beyond MC. Microscopic vascular invasion (hazard ratio [HR], 2.83), satellite nodules (HR, 2.46), tumor size >3 cm (HR, 1.34), poorly differentiated tumor (HR, 3.18), and liver cirrhosis (HR, 1.90) correlated with nontransplantability due to recurrence beyond MC.
"The high risk of failure of ST after initial LR for HCC within MC advocates the use of tissue analysis as selection criteria. The salvage LT strategy should be restricted to patients with favorable oncological factors," the authors write.