Do Tumor Characteristics and Pre-Transplant Locoregional Therapy Predict Survival after OLT in Patients with Hepatocellular Carcinoma?

Kohla, Mohamed and Shaw, Richard and Hisatak, Garret and Osorio, Robert and Bonacini, Maurizio (2013) Do Tumor Characteristics and Pre-Transplant Locoregional Therapy Predict Survival after OLT in Patients with Hepatocellular Carcinoma? International Journal of Clinical Medicine, 04 (12). pp. 25-31. ISSN 2158-284X

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Abstract

HCC prognosis after OLT is associated with criteria related to the number and size. However, the degree of differentiation and efficacy of locoregional therapies may also influence outcome. Aim: Characterize patients with and without HCC and compare outcomes according to tumor characteristics. Methods: Retrospective query of an electronic medical record of 328 patients transplanted at California Pacific Medical Center (CPMC) in 2001-2007. HCC was defined by pre-OLT listing data as well as the finding of a tumor consistent with HCC at liver explant. Milan and UCSF criteria were applied to the lesions as described by pathology upon explant examination. Results: 328 patients were evaluated, with 109 liver malignancies, 103 females (26 (25%) HCC) and 225 males (83 (37%) HCC p = 0.04). HCC patients were older (56 ± 7.2 yr) than non HCC patients (51 ± 9.2, p < 0.001). The age of the donor and cold ischemia time was not different in the 2 groups. Survival was shorter in HCC (mean 984 ± 599 days) vs. non HCC (1103 ± 642) but not statistically significant (p = 0.10). Kaplan Meier survivals were superposable when comparing patients with or without malignancy and when patients with low (≤22) vs. high MELD (>22) were compared. Survival curves in patients that fulfilled Milan vs. UCSF criteria were identical. However, more patients outside Milan died of metastatic disease (5/6, 83%) vs. within Milan (6/14, 43%, p = 0.01). Cox proportional hazards regression showed that MELD, but not malignancy, differentiation or necrosis, was associated with mortality; HR = 6% (95% C.I. 1%-10%) per additional MELD point (p = 0.02). 69 pts had TACE pre-OLT, 17 had RFA ± any other modality. There was no difference in survivals in pts who received any locoregional therapy vs. those who did not (p

Item Type: Article
Subjects: STM Digital Library > Medical Science
Depositing User: Unnamed user with email support@stmdigitallib.com
Date Deposited: 12 Jan 2023 10:23
Last Modified: 29 Jun 2024 11:26
URI: http://archive.scholarstm.com/id/eprint/137

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