Impact of eleven prognostic scores on intra- and extrahepatic recurrence of hepatocellular carcinoma after liver transplantation

Introduction:

Tumor recurrence is the most frequent cause of death after liver transplantation for hepatocellular carcinoma. We selected ten other prognostic classifications to evaluate their potential to predict the risk of recurrence after LT for HCC as compared to the Milan classification. All of the other scores have not been compared one with another in a single cohort.

Methods:

Data of 147 consecutive patients transplanted at our department between 1996 and 2014 were analyzed and staged for morphological and functional scores of underlying liver disease. For long-term follow up, we analyzed separately intrahepatic (within the liver ± distant metastases) and extrahepatic (distant metastases only) recurrence.

Results and conclusions:

The median survival time for all patients was 106 months. The 5- and 10-year observed survival rates were 61% and 43%, respectively. The observed cumulative 5- and 10-year recurrence rates were 37% and 39%, respectively, 10- year intrahepatic and extrahepatic recurrence rates were 12% and 27%, respectively. Median survival time after diagnosis of first recurrence was 7.5 (0 – 120) months; 2 months and 18 months for all, intra- and extrahepatic recurrence, respectively.

UCSF-, Up to seven-, Shanghai Fudan- or Duvoux-classifications can identify patients with a cumulative 10 year recurrence rate below 20%. The pre-therapeutic AFP level should be considered in addition to the geometry of the intrahepatic lesions.