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Factors Affecting Long-term Patient Survival

Okechukwu N. Ojogho, MD; Samuel K. S. So, MD; Emmet B. Keeffe, MD; William Berquist, MD; Waldo Concepcion, MD; Richard Garcia-Kennedy, MD; Joanne Imperial, MD; Carlos O. Esquivel, MD, PhD

Arch Surg. 1996;131(9):935-941.

Abstract
Objective
To determine the influence of several clinicopathologic factors on the 3-year actuarial survival of patients with nonfibrolamellar hepatocellular carcinoma (HCC) following orthotopic liver transplantation (OLT).

Design
A case series of 26 consecutive patients with HCC treated with OLT, with a maximum follow-up of 90 months.

Setting
A tertiary care center.

Patients
Between March 1988 and December 1993, 521 OLTs were performed in 480 patients, 27 of whom had HCC. One patient was excluded because of donortransmitted melanoma. Of the remaining 26 patients, there were 18 adults and 8 children, with a mean age of 41 years (range, 0.2-67.4 years). Fourteen patients (54%) had either hepatitis B (n=6) or hepatitis C (n=8), while 15 (58%) had coincidental tumor.

Intervention
OLT was performed using standard techniques.

Main Outcome Measures
The effect of several clinicopathologic factors on 3-year actuarial patient survival.

Results
The overall actuarial survival rates for the 26 patients with HCC were 73%, 65.4%, and 65.4%, at 1, 2, and 3 years, respectively. Sixteen patients (62%) were alive at the time of this report, with 14 (54%) free of disease. None of the clinicopathologic factors significantly affected the 3-year patient survival rate. However, the rate of recurrent HCC was significantly higher in nonincidental vs coincidental tumors and in solitary vs multiple tumors.

Conclusion
Our results suggest that HCC should not contraindicate OLT, as long-term patient survival and cure can be achieved. While patient selection is important, survival in patients with HCC after OLT is not always predictable using the usual clinicopathologic prognostic factors.

Arch Surg. 1996;131:935-941

Author Affiliations
From the Departments of Surgery (Drs Ojogho, So, Berquist, Concepcion, and Esquivel) and Medicine (Drs Keeffe and Imperial), Stanford University Medical Center, Stanford, Calif; and Department of Pathology, California Pacific Medical Center, San Francisco (Dr Garcia-Kennedy).

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