Liver Transplantation for Hepatocellular Carcinoma: A Single Center Resume Overlooking Four Decades of Experience

Figure 9

Cumulative survival after LT for HCC (HCC recurrence related deaths only) () (for statistics see Table 4). (a) With the exception of a better survival comparing the hepatitis C versus cryptogenic cirrhosis subcategories there were no other significant differences for survival related to underlying diseases. (b) Survival for UICC I and II staged tumors was comparable to the reference category (no or necrotic tumors), while the risk for HCC recurrence death increased significantly and equivalently with each step of UICC-7 staging above IIIA. (c) Tumors outside the histologic MILAN were significant hazards for survival. Nevertheless, even in the group of patients transplanted outside the histologic MILAN (hMILAN) the cumulative survival was 30% at 25 years after liver transplantation. The cumulative survival of patients who were transplanted inside the histologic MILAN (hMILAN) was 72% at 30 years after liver transplantation. (d) Small (V1) and large (V2) vascular infiltration were significant hazards for a HCC recurrence related death, while tumors without (V0) vascular infiltration were no significant hazards for survival compared to the reference category of no or necrotic tumors. (e) Neoadjuvant therapy in general decreased the HCC recurrence related death rate significantly. (f) Tumor grading was a significant predictor of survival. While G1 staged tumors had no increased risk for HCC recurrence related death compared to the reference category (no or necrotic tumors), G2 and G3-4 graded tumors were identified as significant hazards for HCC recurrence related deaths. The risk to die from HCC recurrence after liver transplantation was twice as high for G3-4 tumors as compared to G2 graded tumors.

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