P-0091 - Incidental Hepatocellular Carcinoma: a hidden foe for liver transplant recipients?
|Date||28 June 2014|
|Event||World GI 2014|
|Topics|| Hepatobiliary Cancers
Cancer Aetiology, Epidemiology, Prevention
|Citation||Annals of Oncology (2014) 25 (suppl_2): ii14-ii104. 10.1093/annonc/mdu165|
R. Senkerikova, S. Frankova, J. Sperl, M. Oliverius, J. Fronek, E. Kieslichova, H. Filipova, D. Kautznerova, E. Honsova, P. Trunecka
Orthotopic liver transplantation (OLT) currently represents the treatment of choice in patients with early hepatocellular carcinoma (HCC). Despite the increasing quality of HCC screening methods in patients at risk, distinction of HCC from dysplastic nodules in cirrhotic liver before OLT remains difficult. Therefore, hepatocellular carcinoma detected incidentally in the liver explant after OLT, denoted as incidental HCC (iHCC), is not infrequent. The aim of our study was a comprehensive analysis of post-tranplantant survival of patients with iHCC in our center, comparison of their survival rate with patients with preoperatively known HCC (pkHCC) and identifying risk factors of iHCC occurrence in cirrhotic liver.
We retrospectively reviewed 33 adult cirrhotic patients with incidentally found HCC comparing them with 606 tumour-free cirrhotic patients (group Ci) who underwent OLT in our centre between 1/1995 and 8/2012. Within the same period, a total of 84 patients were transplanted for pkHCC.
There was no difference in sex, MELD score and time spent on the waiting list in both groups. In the multivariate analysis we identified the age >57 years (odds ratio (OR) 3.37, 95% confidence interval (CI) 1.75-8.14, P < .001), HCV or alcohol liver disease (ALD) (OR 3.89, 95% CI 1.42-10.7, P<.001) and AFP level>6.4 µg/l (OR 6.65, 95% CI 2.82-15.7, P = .002) to be independent predictors for occurrence of iHCC. Either 1-, 3- and 5-year overall survival (OS) or 1-, 3- and 5-year recurrence-free survival (RFS) differed in iHCC patients compared with Ci group (iHCC: OS 79%, 72% and 68%, respectively; RFS 79%, 72% and 63%, respectively, vs. Ci group: OS = RFS 93%, 94% and 87%, respectively; P < .001).
We conclude that the survival of iHCC patients is worse than in tumour-free cirrhotic patients, but comparable with survival of pkHCC patients. Independent risk factors for iHCC occurrence in cirrhotic liver are age, HCV or ALD aetiology of liver cirrhosis and AFP level.