Alpha-fetoprotein and tumour size are associated with microvascular invasion in explanted livers of patients undergoing transplantation with hepatocellular carcinoma

Patrick P. McHugh, Jeffrey Gilbert, Santiago Vera, Alvaro Koch, Dinesh Ranjan, Roberto Gedaly

Research output: Contribution to journalArticlepeer-review

105 Scopus citations

Abstract

Background: To determine factors associated with outcomes and microvascular invasion (MVI) in patients undergoing liver transplantation (LT) for hepatocellular carcinoma (HCC). Methods: Between July 1996 and August 2008 at the Universities of Kentucky or Tennessee, LT recipients were retrospectively analysed. Results: One hundred and one patients had HCC in the explanted liver; one patient was excluded because of fibrolamellar histology. Seventy-nine (79%) were male and 81 (81%) were older than 50. HCC was incidental in 32 patients (32%). Median follow-up was 31 months. Ten patients (10%) developed recurrence, which was associated with poor survival (P = 0.006). Overall 1-, 3-, and 5-year survival rates were 87%, 69% and 62%, respectively. Excluding patients with lymph node metastasis (LNM) or MVI yielded 91%, 81% and 75% survival at the same time points. MVI was independently associated with recurrence (OR 28.40, 95% CI 1.77-456.48, P = 0.018) and decreased survival (OR 4.70, 95% CI 1.24-17.80, P = 0.023), and LNM with decreased survival (OR 6.05, 95% CI 1.23-29.71, P = 0.027). Tumour size (OR 4.1, 95% CI 1.2-13.5, P = 0.013) and alpha-fetoproptein (AFP) > 100 (OR 5.0, 95% CI 1.4-18.1, P = 0.006) were associated with MVI. Conclusions: MVI greatly increases the risk of recurrence and death after LT for HCC, and is strongly associated with tumour size and AFP > 100.

Original languageEnglish
Pages (from-to)56-61
Number of pages6
JournalHPB
Volume12
Issue number1
DOIs
StatePublished - Feb 2010

Keywords

  • Hepatocellular carcinoma
  • Liver transplantation
  • Microvascular invasion

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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