Publication: Vascular invasion and survival after liver transplantation for hepatocellular carcinoma: a study from the European Liver Transplant Registry.
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Date
2018-04-03
Authors
Pommergaard, Hans-Christian
Rostved, Andreas A
Adam, René
Thygesen, Lau C
Salizzoni, Mauro
Gómez Bravo, Miguel A
Cherqui, Daniel
Filipponi, Franco
Boudjema, Karim
Mazzaferro, Vincenzo
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Abstract
Studies suggest that vascular invasion may be a superior prognostic marker compared with traditional selection criteria, e.g. Milan criteria. This study aimed to investigate the prognostic value of micro and macrovascular invasion in a large database material. Patients liver transplanted for HCC and cirrhosis registered in the European Liver Transplant Registry (ELTR) database were included. The association between the Milan criteria, Up-to-seven criteria and vascular invasion with overall survival and HCC specific survival was investigated with univariate and multivariate Cox regression analyses. Of 23,124 patients transplanted for HCC, 9324 had cirrhosis and data on explant pathology. Patients without microvascular invasion, regardless of number and size of HCC nodules, had a five-year overall survival of 73.2%, which was comparable with patients inside both Milan and Up-to-seven criteria. Patients without macrovascular invasion had an only marginally reduced survival of 70.7% after five years. Patients outside both Milan and Up-to-seven criteria without micro or macrovascular invasion still had a five-year overall survival of 65.8%. Vascular invasion as a prognostic indicator remains superior to criteria based on size and number of nodules. With continuously improving imaging studies, microvascular invasion may be used for selecting patients for transplantation in the future.
Description
MeSH Terms
Aged
Biopsy
Carcinoma, Hepatocellular
Clinical Decision-Making
Databases, Factual
Europe
Female
Humans
Liver Neoplasms
Liver Transplantation
Male
Middle Aged
Neoplasm Invasiveness
Patient Selection
Registries
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
Biopsy
Carcinoma, Hepatocellular
Clinical Decision-Making
Databases, Factual
Europe
Female
Humans
Liver Neoplasms
Liver Transplantation
Male
Middle Aged
Neoplasm Invasiveness
Patient Selection
Registries
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome