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Liver transplant may be an option for some patients with unresectable HCC

Patients with unresectable hepatocellular carcinomas but otherwise normal livers may benefit from transplantation, according to recent results.

Researchers evaluated 105 patients in the European Liver Transplant Registry who received transplants between January 1994 and December 2005 because of unresectable non-cirrhotic hepatocellular carcinoma (NC-HCC). Incorporated data included patient information, tumor characteristics and survival rates. No participants had signs of fibrosis, cirrhosis or other liver disease, and all tested negative for HBV and HCV.

Sixty-two patients underwent transplant as primary treatment, with 43 patients receiving transplants as rescue therapy following liver resection, with a median of 23 months between procedures. Participants had a median number of three tumors with a median size of 8 cm. Overall survival rates across the entire cohort were 84% at 1 year and 49% at 5 years, with a median of 75 months. Tumor-free survival rates were 76% at 1 year and 43% at 5 years. Differences between overall and tumor-free survival were not significant across the cohort or in the two subgroups.

Factors associated with increased risk through multivariate analysis included macrovascular invasion (HR=2.55; 95% CI, 1.34-4.86), lymph node involvement (HR=2.60; 95% CI, 1.28-5.28) and less than 12 months between resection and transplant (HR=2.12; 95% CI, 0.96-4.67). Patients without macrovascular invasion or lymph node involvement had an overall 5-year survival rate of 59% (95% CI, 47%-70%), compared with a rate of 16% (95%, 0%-36%) among those with both risk factors. Patients lacking all three risk factors had a survival rate of 83% (95% CI, 68%-98%). No association was found between survival rate and tumor size.

“This is the largest reported series of patients transplanted for NC-HCC,” the researchers wrote. “Our findings indicate that liver transplantation may be justified as a curative treatment option in a selected group of patients with unresectable HCC in an otherwise normal liver. Partial liver resection, however, should always be the treatment of first choice.”