Original Paper

Journal of Cancer Research and Clinical Oncology

, Volume 135, Issue 10, pp 1403-1412

First online:

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

  • Jia FanAffiliated withLiver Cancer Institute, Shanghai Medical School, Zhong Shan Hospital, Fudan University Email author 
  • , Guang-Shun YangAffiliated withDong Fang Gan Dan Hospital, Shanghai Second Military Medical University
  • , Zhi-Ren FuAffiliated withChang Zheng Hospital, Shanghai Second Military Medical University
  • , Zhi-Hai PengAffiliated withShanghai First Hospital, Medical School of Jiaotong University
  • , Qiang XiaAffiliated withRen Ji Hospital, Medical School of Jiaotong University
  • , Chen-Hong PengAffiliated withRui Jing Hospital, Medical School of Jiaotong University
  • , Jian-Ming QianAffiliated withHua Shan Hospital, Shanghai Medical School, Fudan University
  • , Jian ZhouAffiliated withLiver Cancer Institute, Shanghai Medical School, Zhong Shan Hospital, Fudan University
  • , Yang XuAffiliated withLiver Cancer Institute, Shanghai Medical School, Zhong Shan Hospital, Fudan University
    • , Shuang-Jian QiuAffiliated withLiver Cancer Institute, Shanghai Medical School, Zhong Shan Hospital, Fudan University
    • , Lin ZhongAffiliated withShanghai First Hospital, Medical School of Jiaotong University
    • , Guang-Wen ZhouAffiliated withRui Jing Hospital, Medical School of Jiaotong University
    • , Jian-Jun ZhangAffiliated withRen Ji Hospital, Medical School of Jiaotong University

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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 carcinoma Liver transplantation Criteria Prognosis