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PREDCTIVE FACTORS OF HCC RECURRENCE AFTER LIVER TRANSPLANTATION (OLT) : AN
INTERIM ANALYSIS
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S. Gianni*, 1, 2 F.V. Mirante, 2 R. Fassati, 2 D. Forti, 2 V. Mazzaferro, 2
U. Cillo, 1, 2 A. Maffei Faccioli, 2 G.L. Grazi, 2 M. Salizzoni, 2 F.
Filipponi, 2 M. Castagneto, 2 G. Tisone, 2 U. Valente, 2 F. Farinati, 1, 2 M.
Pompili, 2 G. Gasbarrini, 2 R. Naccarato, 1, 2 S. Fagiuoli, 1, 2
*Presenting Author
1Department Of Surgical And Gastroentrological Sciences, Padua, Italy
2Monotematica 2000 AISF OLT Study Group, Padua, Italy
Background: HCC represents a frequent indication for OLT, however recurrence
is common in advanced neoplasms. Aim: To evaluate potential predictive
factors of HCC recurrence after OLT. Methods: We evaluated the role of
hypothesized predictive factors of recurrence in a large series of
transplants (587) in HCC, performed between '86 and '99 in Italy. Results:
HCC recurrence occurred in 11.1% of the patients and represents the major
cause of death (83, 7%). Mean time of HCC recurrence was 16, 75±13, 9 (median
12 m.). Morpho-biological parameters that significantly related with
recurrence were: tumor bilobarity (p=0, 006), number of nodules (>3; p<0,
0001), size of nodules (>5cm; p<0, 0001), absence of Milano's selection
criteria (p=0, 0004), non-incidental diagnosis (p=0, 01), high levels of _FP
(p=0, 02). Hystological parameters significantly related with recurrence
were: microvascular invasion (p=0, 004), satellitosis (p<0, 0001). When all
the above parameters were introduced in a multiple regression analysis, the
following variables were selected as independent predictor of recurrence:
size and number of nodules (p<0, 0001 and p=0, 05, respectively), incidental
diagnosis (p=0, 013), satellitosis (p=0, 008), _FP levels (p=0, 008),
microvascular invasion (p=0, 019) and thrombosis (p=0, 05). Pre-OLT
neoadjuvant treatment significantly prolonged post-OLTdisease-free survival.
Conclusions: HCC recurrence rate was 11, 1% at median time of 1 year after
OLT, HCC being the main cause of death. The strongest predictive factors of
post-transplant HCC recurrence are: size and number of nodules,
non-incidental diagnosis, satellitosis, micro/macrovascular invasion and high
AFP levels. These data suggest that the expansion of size criteria could
negatively affect recurrence rates. Further investigations based on
prospective studies are required.
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