Twenty-year experience with liver transplantation for hepatocellular carcinoma

Eddie R. Island, James Pomposelli, Elizabeth A. Pomfret, Fredric D. Gordon, W. David Lewis, Roger L. Jenkins, Thomas Colacchio, Thomas Tracy, James Whiting, Blake Cady

Research output: Contribution to journalReview article

31 Citations (Scopus)

Abstract

Hypothesis: Liver transplantation (LT) has become the optimal treatment for stages I and II hepatocellular carcinoma (HCC). Based on our 20-year experience, changes in staging, techniques, and patient selection have improved survival over the past 20 years. Herein, we determine if pre-LT treatment for HCC alters the long-term outcomes in patients with HCC. Design: Outcomes study. Setting: Tertiary referral center. Patients: We retrospectively reviewed prospectively collected data in a cohort of 92 patients who underwent LT for HCC between 1983 and 2003. Main Outcome Measures: Patient demographics, tumor stage in the explant liver, patient survival, and tumor recurrence data were analyzed. Results: The average follow-up was 1052 (range, 0-6491) days. The average tumor size was 3.6 cm; 40% of tumors were multifocal and 60% unifocal. Of the 92 patients, 26% were classified as stage I; 42%, stage II; 24%, stage III; and 8%, stage IV. The overall 5-year survival rate was 50%, the 10-year survival rate was 32%, and the 15-year survival rate was 27%. Improvements in staging in the last 5 years reduced the number of patients with stages III and IV HCC from 39% to 19% and increased the 5-year survival rate to 69%. Tumor recurrence was relatively rare (13%); however, recurrence resulted in a poor prognosis (75% mortality rate; P = .02). The average time to recurrence was 458 (range, 179-1195) days. Conclusions: Liver transplantation for HCC results in excellent long-term survival for patients with stages 1 and II HCC, with relatively few patients dying from tumor recurrence. Improvements in preoperative staging have resulted in increased 5-year survival rates. Further refinements in pre-LT staging may increase the effectiveness of LT for HCC.

Original languageEnglish (US)
Pages (from-to)353-358
Number of pages6
JournalArchives of Surgery
Volume140
Issue number4
DOIs
StatePublished - Apr 1 2005

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Liver Transplantation
Hepatocellular Carcinoma
Survival Rate
Recurrence
Neoplasms
Survival
Outcome Assessment (Health Care)
Tertiary Care Centers
Patient Selection
Demography
Mortality
Liver
Therapeutics

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Island, E. R., Pomposelli, J., Pomfret, E. A., Gordon, F. D., Lewis, W. D., Jenkins, R. L., ... Cady, B. (2005). Twenty-year experience with liver transplantation for hepatocellular carcinoma. Archives of Surgery, 140(4), 353-358. https://doi.org/10.1001/archsurg.140.4.353
Island, Eddie R. ; Pomposelli, James ; Pomfret, Elizabeth A. ; Gordon, Fredric D. ; Lewis, W. David ; Jenkins, Roger L. ; Colacchio, Thomas ; Tracy, Thomas ; Whiting, James ; Cady, Blake. / Twenty-year experience with liver transplantation for hepatocellular carcinoma. In: Archives of Surgery. 2005 ; Vol. 140, No. 4. pp. 353-358.
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abstract = "Hypothesis: Liver transplantation (LT) has become the optimal treatment for stages I and II hepatocellular carcinoma (HCC). Based on our 20-year experience, changes in staging, techniques, and patient selection have improved survival over the past 20 years. Herein, we determine if pre-LT treatment for HCC alters the long-term outcomes in patients with HCC. Design: Outcomes study. Setting: Tertiary referral center. Patients: We retrospectively reviewed prospectively collected data in a cohort of 92 patients who underwent LT for HCC between 1983 and 2003. Main Outcome Measures: Patient demographics, tumor stage in the explant liver, patient survival, and tumor recurrence data were analyzed. Results: The average follow-up was 1052 (range, 0-6491) days. The average tumor size was 3.6 cm; 40{\%} of tumors were multifocal and 60{\%} unifocal. Of the 92 patients, 26{\%} were classified as stage I; 42{\%}, stage II; 24{\%}, stage III; and 8{\%}, stage IV. The overall 5-year survival rate was 50{\%}, the 10-year survival rate was 32{\%}, and the 15-year survival rate was 27{\%}. Improvements in staging in the last 5 years reduced the number of patients with stages III and IV HCC from 39{\%} to 19{\%} and increased the 5-year survival rate to 69{\%}. Tumor recurrence was relatively rare (13{\%}); however, recurrence resulted in a poor prognosis (75{\%} mortality rate; P = .02). The average time to recurrence was 458 (range, 179-1195) days. Conclusions: Liver transplantation for HCC results in excellent long-term survival for patients with stages 1 and II HCC, with relatively few patients dying from tumor recurrence. Improvements in preoperative staging have resulted in increased 5-year survival rates. Further refinements in pre-LT staging may increase the effectiveness of LT for HCC.",
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Island, ER, Pomposelli, J, Pomfret, EA, Gordon, FD, Lewis, WD, Jenkins, RL, Colacchio, T, Tracy, T, Whiting, J & Cady, B 2005, 'Twenty-year experience with liver transplantation for hepatocellular carcinoma', Archives of Surgery, vol. 140, no. 4, pp. 353-358. https://doi.org/10.1001/archsurg.140.4.353

Twenty-year experience with liver transplantation for hepatocellular carcinoma. / Island, Eddie R.; Pomposelli, James; Pomfret, Elizabeth A.; Gordon, Fredric D.; Lewis, W. David; Jenkins, Roger L.; Colacchio, Thomas; Tracy, Thomas; Whiting, James; Cady, Blake.

In: Archives of Surgery, Vol. 140, No. 4, 01.04.2005, p. 353-358.

Research output: Contribution to journalReview article

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T1 - Twenty-year experience with liver transplantation for hepatocellular carcinoma

AU - Island, Eddie R.

AU - Pomposelli, James

AU - Pomfret, Elizabeth A.

AU - Gordon, Fredric D.

AU - Lewis, W. David

AU - Jenkins, Roger L.

AU - Colacchio, Thomas

AU - Tracy, Thomas

AU - Whiting, James

AU - Cady, Blake

PY - 2005/4/1

Y1 - 2005/4/1

N2 - Hypothesis: Liver transplantation (LT) has become the optimal treatment for stages I and II hepatocellular carcinoma (HCC). Based on our 20-year experience, changes in staging, techniques, and patient selection have improved survival over the past 20 years. Herein, we determine if pre-LT treatment for HCC alters the long-term outcomes in patients with HCC. Design: Outcomes study. Setting: Tertiary referral center. Patients: We retrospectively reviewed prospectively collected data in a cohort of 92 patients who underwent LT for HCC between 1983 and 2003. Main Outcome Measures: Patient demographics, tumor stage in the explant liver, patient survival, and tumor recurrence data were analyzed. Results: The average follow-up was 1052 (range, 0-6491) days. The average tumor size was 3.6 cm; 40% of tumors were multifocal and 60% unifocal. Of the 92 patients, 26% were classified as stage I; 42%, stage II; 24%, stage III; and 8%, stage IV. The overall 5-year survival rate was 50%, the 10-year survival rate was 32%, and the 15-year survival rate was 27%. Improvements in staging in the last 5 years reduced the number of patients with stages III and IV HCC from 39% to 19% and increased the 5-year survival rate to 69%. Tumor recurrence was relatively rare (13%); however, recurrence resulted in a poor prognosis (75% mortality rate; P = .02). The average time to recurrence was 458 (range, 179-1195) days. Conclusions: Liver transplantation for HCC results in excellent long-term survival for patients with stages 1 and II HCC, with relatively few patients dying from tumor recurrence. Improvements in preoperative staging have resulted in increased 5-year survival rates. Further refinements in pre-LT staging may increase the effectiveness of LT for HCC.

AB - Hypothesis: Liver transplantation (LT) has become the optimal treatment for stages I and II hepatocellular carcinoma (HCC). Based on our 20-year experience, changes in staging, techniques, and patient selection have improved survival over the past 20 years. Herein, we determine if pre-LT treatment for HCC alters the long-term outcomes in patients with HCC. Design: Outcomes study. Setting: Tertiary referral center. Patients: We retrospectively reviewed prospectively collected data in a cohort of 92 patients who underwent LT for HCC between 1983 and 2003. Main Outcome Measures: Patient demographics, tumor stage in the explant liver, patient survival, and tumor recurrence data were analyzed. Results: The average follow-up was 1052 (range, 0-6491) days. The average tumor size was 3.6 cm; 40% of tumors were multifocal and 60% unifocal. Of the 92 patients, 26% were classified as stage I; 42%, stage II; 24%, stage III; and 8%, stage IV. The overall 5-year survival rate was 50%, the 10-year survival rate was 32%, and the 15-year survival rate was 27%. Improvements in staging in the last 5 years reduced the number of patients with stages III and IV HCC from 39% to 19% and increased the 5-year survival rate to 69%. Tumor recurrence was relatively rare (13%); however, recurrence resulted in a poor prognosis (75% mortality rate; P = .02). The average time to recurrence was 458 (range, 179-1195) days. Conclusions: Liver transplantation for HCC results in excellent long-term survival for patients with stages 1 and II HCC, with relatively few patients dying from tumor recurrence. Improvements in preoperative staging have resulted in increased 5-year survival rates. Further refinements in pre-LT staging may increase the effectiveness of LT for HCC.

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Island ER, Pomposelli J, Pomfret EA, Gordon FD, Lewis WD, Jenkins RL et al. Twenty-year experience with liver transplantation for hepatocellular carcinoma. Archives of Surgery. 2005 Apr 1;140(4):353-358. https://doi.org/10.1001/archsurg.140.4.353