Journal of Cancer Research and Clinical Oncology

, Volume 135, Issue 10, pp 1403–1412

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

  • Jia Fan
  • Guang-Shun Yang
  • Zhi-Ren Fu
  • Zhi-Hai Peng
  • Qiang Xia
  • Chen-Hong Peng
  • Jian-Ming Qian
  • Jian Zhou
  • Yang Xu
  • Shuang-Jian Qiu
  • Lin Zhong
  • Guang-Wen Zhou
  • Jian-Jun Zhang
Original Paper

DOI: 10.1007/s00432-009-0584-6

Cite this article as:
Fan, J., Yang, G., Fu, Z. et al. J Cancer Res Clin Oncol (2009) 135: 1403. doi:10.1007/s00432-009-0584-6

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 ≤9 cm in diameter, no more than three lesions with the largest ≤5 cm, a total tumor diameter ≤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.

Keywords

Hepatocellular carcinomaLiver transplantationCriteriaPrognosis

Abbreviations

HCC

Hepatocellular carcinoma

LT

Liver transplantation

TNM

Tumor-node-metastasis

US

Ultrasonography

CT

Computed tomography

MRI

Magnetic resonance imaging

WHO

World Health Organization

MMF

Mycophenolate mofetil

SRL

Sirolimus

TACE

Transcatheter arterial chemoembolization

PEI

Percutaneous ethanol injection

RFA

Radio-frequency ablation

OS

Overall survival

DFS

Disease-free survival

AFP

Alpha-fetoprotein

CPT

Child-Pugh-Turcotte

UICC

International Union against cancer

HBV

Hepatitis B virus

HBsAg

Hepatitis B surface antigen

HCV

Hepatitis C virus

PET

Positron emission tomography

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Jia Fan
    • 1
  • Guang-Shun Yang
    • 2
  • Zhi-Ren Fu
    • 3
  • Zhi-Hai Peng
    • 4
  • Qiang Xia
    • 5
  • Chen-Hong Peng
    • 6
  • Jian-Ming Qian
    • 7
  • Jian Zhou
    • 1
  • Yang Xu
    • 1
  • Shuang-Jian Qiu
    • 1
  • Lin Zhong
    • 4
  • Guang-Wen Zhou
    • 6
  • Jian-Jun Zhang
    • 5
  1. 1.Liver Cancer Institute, Shanghai Medical School, Zhong Shan HospitalFudan UniversityShanghaiPeople’s Republic of China
  2. 2.Dong Fang Gan Dan HospitalShanghai Second Military Medical UniversityShanghaiPeople’s Republic of China
  3. 3.Chang Zheng HospitalShanghai Second Military Medical UniversityShanghaiPeople’s Republic of China
  4. 4.Shanghai First HospitalMedical School of Jiaotong UniversityShanghaiPeople’s Republic of China
  5. 5.Ren Ji HospitalMedical School of Jiaotong UniversityShanghaiPeople’s Republic of China
  6. 6.Rui Jing HospitalMedical School of Jiaotong UniversityShanghaiPeople’s Republic of China
  7. 7.Hua Shan Hospital, Shanghai Medical SchoolFudan UniversityShanghaiPeople’s Republic of China