This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Schlitt, H. J. Articles by Pichlmayr, R. Search for Related Content PubMed PubMed Citation Articles by Schlitt, H. J. Articles by Pichlmayr, R.

Recurrence Patterns of Hepatocellular and Fibrolamellar Carcinoma After Liver Transplantation

Hans J. Schlitt, Michael Neipp, Arved Weimann, Karl J. Oldhafer, Ekkehard Schmoll, Klaus Boeker, Björn Nashan, Stefan Kubicka, Hansjörg Maschek, Günter Tusch, Rudolf Raab, Burckhardt Ringe, Michael P. Manns, Rudolf Pichlmayr

From the Klinik für Abdominal-und Transplantationschirurgie; Abteilung Hämatologie und Onkologie; Abteilung Gastroenterologie und Hepatologie; Institut für Pathologie; and Abteilung Biometrie, Medizinische Hochschule Hannover, Hannover, Germany.

Address reprint requests to Priv.-Doz. Dr. Hans J. Schlitt, Klinik für Abdominal- und Transplantationschirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Str 1, D-30623 Hannover, Germany; Email schlitt{at}tx-amb.mh-hannover.de

PURPOSE: Tumor recurrence is the major limitation of long-term survival after liver transplantation for hepatocellular carcinoma (HCC) or fibrolamellar carcinoma (FLC). Understanding tumor-biologic characteristics is important for selection of patients and for development of adjuvant therapeutic strategies.

PATIENTS AND METHODS: The study included 69 patients who underwent potentially curative liver transplantation for HCC/FLC and survived for more than 150 days; minimum follow-up was 33 months. Frequency, localization, and timing of recurrence were analyzed and compared with primary tumor and patient characteristics.

RESULTS: Tumor recurrence was observed in 39 patients at 67 locations. Hematogenous spread was the major route of tumor recurrence (87%), and the most frequent sites were the liver (62%), lung (56%), and bone (18%). Parameters associated with recurrence were absence of cirrhosis, tumor size greater than 5 cm, more than five nodules, vascular infiltration, and International Union Against Cancer (UICC) stage IVA. Selective intrahepatic recurrence was found in nine patients (23%); it was associated with highly differentiated tumors, lack of vascular infiltration, and male sex. Recurrence at multiple sites was found predominantly in young patients ( 40 years) and for multicentric (> 5) primary tumors. Recurrences were observed within a wide time range after transplantation (43 to 3,204 days; median, 441 days); late recurrences (> 1,000 days, n = 8) were associated with highly differentiated or fibrolamellar tumors and low UICC stages. Surgical treatment was the only therapeutic option associated with prolonged survival after recurrence.

CONCLUSION: In transplant recipients, hepatocellular carcinomas vary considerably in their pattern and kinetics of metastases. Tumor cells may persist in a dormant state for long time periods before giving rise to clinical metastases. Surgical treatment of recurrence should be considered whenever possible.

Deceased.

This article has been cited by other articles:

				M. J. Bates, E. Farkas, D. Taylor, and P. M. McFadden Pulmonary Resection of Metastatic Hepatocellular Carcinoma After Liver Transplantation Ann. Thorac. Surg., February 1, 2008; 85(2): 412 - 415. [Abstract] [Full Text] [PDF]

				M. A. Zimmerman, R. M. Ghobrial, M. J. Tong, J. R. Hiatt, A. M. Cameron, J. Hong, and R. W. Busuttil Recurrence of Hepatocellular Carcinoma Following Liver Transplantation: A Review of Preoperative and Postoperative Prognostic Indicators Arch Surg, February 1, 2008; 143(2): 182 - 188. [Abstract] [Full Text] [PDF]

				C. E. Woodall, C. R. Scoggins, J. Loehle, K. V. Ravindra, K. M. McMasters, and R. C. G. Martin Hepatic Imaging Characteristics Predict Overall Survival in Hepatocellular Carcinoma Ann. Surg. Oncol., October 1, 2007; 14(10): 2824 - 2830. [Abstract] [Full Text] [PDF]

				N. Waguri, T. Suda, M. Nomoto, H. Kawai, Y. Mita, T. Kuroiwa, M. Igarashi, M. Kobayashi, Y. Fukuhara, and Y. Aoyagi Sensitive and Specific Detection of Circulating Cancer Cells in Patients with Hepatocellular Carcinoma; Detection of Human Telomerase Reverse Transcriptase Messenger RNA after Immunomagnetic Separation Clin. Cancer Res., August 1, 2003; 9(8): 3004 - 3011. [Abstract] [Full Text] [PDF]

				R. T.-P. Poon, I. O.-L. Ng, C. Lau, W.-C. Yu, Z.-F. Yang, S.-T. Fan, and J. Wong Tumor Microvessel Density as a Predictor of Recurrence After Resection of Hepatocellular Carcinoma: A Prospective Study J. Clin. Oncol., April 1, 2002; 20(7): 1775 - 1785. [Abstract] [Full Text] [PDF]

				R. T.-P. Poon, S.-T. Fan, C.-M. Lo, C.-L. Liu, I. O.-L. Ng, and J. Wong Long-Term Prognosis After Resection of Hepatocellular Carcinoma Associated With Hepatitis B-Related Cirrhosis J. Clin. Oncol., March 1, 2000; 18(5): 1094 - 1094. [Abstract] [Full Text] [PDF]