Liver transplantation in the treatment of primary liver cancer

Abstract

One hundred and fifteen patients underwent orthotopic liver transplantation (OLT) for primary liver malignancy. Overall survivals of these patients were significantly lower than those of patients with non-malignant diseases (5-year survival rates 37% and 65%, respectively). Hepatocellular carcinoma (HCC) was the most common malignancy among our patients (n = 80). Fibrolamellar HCC (n = 9) was associated with better survival than non-fibrolamellar HCC (N = 71) among the lesions greater than or equal to 5 cm in diameter. More frequent recurrence was noted in patients with large tumors (greater than or equal to 5 cm), multiple tumors, and gross vascular involvement. A significant lower survival rate was observed in patients with bile duct cancer (n = 19) than in those with HCC or epithelioid hemangioendothelioma (n = 8). Careful patient selection and effective adjuvant anti-cancer therapy are needed to improve the results of OLT for primary liver malignancy.

Fig. 1

1.Survival curves of patients with primary liver malignancy (n = 115) and non-malignant diseases (n = 1354) in the period 1980–1988

Fig. 2

2.Survival curves of various types of primary liver malignancy: hepatocellular carcinoma (HCC, n= 80), bile duct cancer (BD Ca) (n = 19), epithelioid hemangioendothelioma (EHE) (n = 8) and others: hepatoblastoma (n=4), cholangiocarcinoma (n = 2) and angiosarcoma (n = 2)

Fig. 3

Survival curves of fibrolamellar HCC (n = 9) and non-fibrolamellar HCC with tumor ≥ 5 cm (n = 43).

Fig. 4

Timing of recurrence in primary hepatic malignancy