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

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Journal of Cancer Research and Clinical Oncology Aims and scope Submit manuscript

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.

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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

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Acknowledgments

This study was supported by combined grants from National Natural Science Foundation of China (No.30873039, 30571801), Shanghai Science and Technology Development Funds (No.06QA14012, No.054119530), Foundation of Shanghai Science Technology Commission (No. 07JC14010, 06xD14004, 044119608 and 07SP07003), the National Key Sci-Tech Special Project of China (No.2008ZX10002-022), and the Program for Excellent Disciplinary Leaders of Shanghai Health Bureau (No.LJ06004). We thank Roche for assistance in the organization of the Shanghai Multi-Center LT Collaborative Group.

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Authors and Affiliations

  1. Liver Cancer Institute, Shanghai Medical School, Zhong Shan Hospital, Fudan University, 136 Yi Xue Yuan Road, 200032, Shanghai, People’s Republic of China

    Jia Fan, Jian Zhou, Yang Xu & Shuang-Jian Qiu

  2. Dong Fang Gan Dan Hospital, Shanghai Second Military Medical University, 225 Chang Hai Road, 200438, Shanghai, People’s Republic of China

    Guang-Shun Yang

  3. Chang Zheng Hospital, Shanghai Second Military Medical University, 435 Fen Yang Road, 200003, Shanghai, People’s Republic of China

    Zhi-Ren Fu

  4. Shanghai First Hospital, Medical School of Jiaotong University, 85 Wu Jing Road, 200080, Shanghai, People’s Republic of China

    Zhi-Hai Peng & Lin Zhong

  5. Ren Ji Hospital, Medical School of Jiaotong University, 145 Shan Dong Zhong Road, 200001, Shanghai, People’s Republic of China

    Qiang Xia & Jian-Jun Zhang

  6. Rui Jing Hospital, Medical School of Jiaotong University, 197 Rui Jing Second Road, 200025, Shanghai, People’s Republic of China

    Chen-Hong Peng & Guang-Wen Zhou

  7. Hua Shan Hospital, Shanghai Medical School, Fudan University, 12 Wu Lu Mu Qi Zhong Road, 200040, Shanghai, People’s Republic of China

    Jian-Ming Qian

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  1. Jia Fan
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  2. Guang-Shun Yang
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  3. Zhi-Ren Fu
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  5. Qiang Xia
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  7. Jian-Ming Qian
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  8. Jian Zhou
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  9. Yang Xu
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  10. Shuang-Jian Qiu
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  11. Lin Zhong
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  12. Guang-Wen Zhou
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  13. Jian-Jun Zhang
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Corresponding author

Correspondence to Jia Fan.

Additional information

J. Fan, G.-S. Yang, Z.-R. Fu, Z.-H. Peng, Q. Xia, C.-H. Peng, J.-M. Qian, J. Zhou and Y. Xu contributed equally to this work.

This is an original work by all the authors from the Shanghai Multi-center Collaborative Liver Transplantation Group.

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Fan, J., Yang, GS., Fu, ZR. et al. Liver transplantation outcomes in 1,078 hepatocellular carcinoma patients: a multi-center experience in Shanghai, China. J Cancer Res Clin Oncol 135, 1403–1412 (2009). https://doi.org/10.1007/s00432-009-0584-6

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  • DOI: https://doi.org/10.1007/s00432-009-0584-6

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