Liver transplantation outcomes in 1,078 hepatocellular carcinoma patients: a multi-center experience in Shanghai, China

Abstract

Purpose: To evaluate current selection criteria for patients undergoing liver transplantation (LT) in response to hepatocellular carcinoma (HCC), and to analyze the prognostic factors for successful transplantation.

Methods: We evaluated the outcome of 1,078 consecutive patients with HCC from the Shanghai Multi-Center Collaborative LT Group who underwent LT over a 6-year period. Clinicopathologic data for these patients were evaluated. The prognostic significance was assessed using Kaplan-Meier survival estimates and log-rank tests. Multivariate study with Cox's proportional hazard model was used to evaluate the prognosis-relative aspects.

Results: We determined that expansion of Milan criteria to include: a solitary lesion < or = 9 cm in diameter, no more than three lesions with the largest < or = 5 cm, a total tumor diameter < or = 9 cm without macrovascular invasion, lymph node invasion and extrahepatic metastasis (referred to as the "Shanghai criteria"), resulted in overall survival (OS) and disease-free survival (DFS) rates that were similar to the Milan criteria. Multivariate analysis using the Cox proportional hazards regression model showed that the Child-Pugh-Turcotte classification (P = 0.010, 0.000), tumor differentiation (P = 0.001, 0.000), tumor size (P = 0.000, 0.000) and number (P = 0.014, 0.016), macrovascular invasion (P = 0.022, 0.000) and alpha-fetoprotein (AFP) levels (P = 0.031, 0.003) were independent predictors of OS and DFS, while post-LT chemotherapy (OS, P = 0.000) and tumor encapsulation (DFS, P = 0.038) were independent predictors of OS or DFS.

Conclusion: Shanghai criteria expanded the current criteria while maintaining similar survival.

Fig. 1

Comparison of overall and disease-free survival between HCC patients undergoing liver transplantation divided by Milan or Shanghai criteria. The OS and DFS were significantly lower for the patients exceeded Milan (a, b) or Shanghai (c, d) criteria than for the patients who met the criteria (P = 0.000). There was no difference in OS and DFS between the patients met Milan criteria and the patients exceeded-Milan-met-Shanghai criteria (e, f, P > 0.05)