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631 OUTCOME OF LIVER TRANSPLANTATION (LT) FOR HEPATOCELLULAR CARCINOMA (HCC) ACCORDING TO DIFFERENT TRANSPLANT CRITERIA: A META-ANALYSIS
POSTERS 631 OUTCOME OF LIVER TRANSPLANTATION (LT) FOR HEPATOCELLULAR CARCINOMA (HCC) ACCORDING TO DIFFERENT TRANSPLANT CRITERIA: A META-ANALYSIS G. Germani1 , M. Garcovich1 , K. Gurusamy2 , C. Toso3 , G. Fede1 , E. Tsochatzis1 , A.K. Burroughs1 . 1 The Royal Free Sheila Sherlock Liver Centre and Division of Surgery, University College London, 2 Hepato-Pancreatico-Biliary and Liver Transplant Unit, University Department of Surgery, Royal Free Campus, UCL Medical School, London, UK; 3 Services de Chirurgie Viscerale et Transplantation Hopitaux Universites de Geneve, Geneva, Switzerland E-mail: [email protected] Background and Aim: LT for HCC and cirrhosis is complicated by the prognosis of both diseases. Milan criteria are derived from explanted specimens, and when used based on pre-transplant imaging, results in a recurrence rate of ≤15%. There has been some evidence that extending selection criteria results in similar, but not increased recurrence rates. The most used extension criteria have been those termed “San Francisco criteria”. However it is not clear when UCSF criteria are extended from Milan, whether the size of the largest nodule or the number or both, is the critical permissive feature. The aim of this meta-analysis was to assessed the impact of different transplant criteria on overall survival (OS), disease-free survival (DFS) and recurrence after LT for HCC. Material and methods: MEDLINE, Cochrane Controlled trial Register (CENTRAL), EMBASE and Science Citation Index databases were searched until April 2010. Results: Fifty studies evaluating overall survival (OS), disease-free survival (DFS) and recurrence according to different criteria for LT in patients with HCC were included: 39 studies (8981 patients) evaluated the impact of Milan criteria (HR for OS 1.63; 95% CI 1.31–2.03, HR for DFS 3.27; 95% CI 2.12–5.05, HR for recurrence 2.79; 95% CI 1.71–4.54 vs. within Milan criteria), 13 studies (1987 patients) evaluated the impact of UCSF criteria (HR for OS 1.79; 95% CI 1–3.21, HR for DFS 3.41; 95% CI 1.21–9.60, HR for recurrence 6.11; 95% CI 2.45–15.23 vs. within UCSF). Two studies (6946 patients) evaluated the impact of outside Milan criteria, but within UCSF criteria (HR for OS 1.39; 95% CI 0.98–1.95 vs. within Milan criteria). Conclusion: Overall, Milan criteria seem to clearly influence the OS and DFS and recurrence after LT. UCSF criteria seem to clearly influence the DFS and recurrence after LT, whereas the impact on OS was borderline with the lower range of HR of 1. It appears that patients transplanted outside Milan criteria, but within UCSF have a non-statistical difference in risk of death compared with patients transplanted within Milan criteria, but this is only based on 2 studies. The results in the literature do not conclusively resolve which selection system better predicts recurrence and survival. 632 DOES THE NUMBER OF HCC NODULES IN CIRRHOSIS IMPACT ON OUTCOME AFTER LIVER TRANSPLANTATION? G. Germani1 , M. Garcovich1 , K. Gurusamy2 , C. Toso3 , G. Fede1 , E. Tsochatzis1 , A.K. Burroughs1 . 1 The Royal Free Sheila Sherlock Liver Centre and Division of Surgery, University College London, 2 Hepato-Pancreatico-Biliary and Liver Transplant Unit, University Department of Surgery, Royal Free Campus, UCL Medical School, London, UK; 3 Services de Chirurgie Viscerale et Transplantation Hopitaux Universites de Geneve, Geneva, Switzerland E-mail: [email protected] Background and Aim: In patients with cirrhosis imaging technique has not altered for the detection of nodules of 2 cm diameter or more, but has improved for the detection of smaller (0.5–1.5 cm size) nodules. Assuming these may have been missed on pretransplant imaging in the past (but only found on explant), then there may already be a case that the number of nodules particularly S256
if small (1–2 cm) may be less important for recurrence. Moreover these small nodules are known to be far less likely to be associated with microvascular invasion. The aim of this meta-analysis was to assessed the impact of tumour number on overall survival (OS), disease-free survival (DFS) and recurrence after LT for HCC. Material and methods: MEDLINE, Cochrane Controlled trial Register (CENTRAL), EMBASE and Science Citation Index databases were searched until April 2010. Results: Fifteen studies (4575 patients) evaluating the impact of tumour nodule number on OS, DFS and recurrence after LT were included: 5 studies (719 patients) reporting nodule number it as a continuous variable (HR for OS 1.09; 95% CI 0.88–1.34, HR for recurrence 1.07; 95% CI 0.93–1.23); 3 studies (468 patients) reporting multiple versus single nodules (HR for OS 1.23; 95% CI 1– 1.53); 7 studies (3289 patients) reporting it as cut-offs (3 nodules) (HR for OS 1.29; 95% CI 1.14–1.46, HR for DFS 1.24; 95% CI 0.77–2.01, HR for recurrence 1.02; 95% CI 0.25–4.24). Conclusions: The number of tumours evaluated as a continuous variable does not appear to have a clear impact on overall survival nor on recurrence. Multiple tumours double the risk of recurrence after LT compared to single tumour, but the impact of multiple tumours on OS is borderline. Patients with ≥3 tumours have an increased risk of death compared to those with <3 tumours. The best data based on a precise evaluation of the number of nodules suggests the relationship to recurrence and survival is not statistically significant suggesting that expansion of selection criteria can include an increased number of nodules, but the cut-off for maximum nodule size cannot be derived. 633 TUMOUR SIZE OF HCC AND ITS RELATIONSHIP TO OUTCOME AFTER LIVER TRANSPLANTATION G. Germani1 , M. Garcovich1 , K. Gurusamy2 , C. Toso3 , G. Fede1 , E. Tsochatzis1 , A.K. Burroughs1 . 1 The Royal Free Sheila Sherlock Liver Centre and Division of Surgery, University College London, 2 Hepato-Pancreatico-Biliary and Liver Transplant Unit, University Department of Surgery, Royal Free Campus, UCL Medical School, London, UK; 3 Services de Chirurgie Viscerale et Transplantation Hopitaux Universites de Geneve, Geneva, Switzerland E-mail: [email protected] Background and Aim: The aim of this meta-analysis was to assessed the impact of tumour size on overall survival (OS), diseasefree survival (DFS) and recurrence after LT for HCC. Material and methods: MEDLINE, Cochrane Controlled trial Register (CENTRAL), EMBASE and Science Citation Index databases were searched until April 2010. Results: Thirty-two studies evaluating the impact of tumour size on overall survival (OS), disease-free survival (DFS) and recurrence after LT were included. Total tumour size was evaluated in 7 studies (1502 patients): as continuous variable in 2 studies (HR for recurrence 1.19, 95% CI 0.95–1.49), as a cut-off of 10 cm in 3 studies (HR for OS 4.59, 95% CI 1.26–16.79), and as a cut-off of 9 cm in 2 studies (HR for DFS 1.98; 95% CI 1.49–2.64). The diameter of the largest tumour was evaluated in 9 studies (2743 patients): as a continuous variable in 3 studies (HR for recurrence 1.03; 95% CI 0.99–1.07), as a cut-off of 3 cm in 6 studies (HR for OS ≥3 cm 1.55; 95% CI 1.29–1.86, HR for recurrence 6.69; 95% CI 2.34–19.12). Tumour size without any other specification was assessed in 19 studies (2497 patients): as a continuous variable in 4 studies (HR for OS 1.14; 95% CI 1–1.30), as a cut-off (5 cm) in 16 studies (HR for OS 1.92; 95% CI 1.48–2.50, HR for DFS 4.30; 95% CI 2.48–7.49, HR for recurrence 2.56; 95% CI 1.53–3.34). Conclusions: Considering total tumour size OS is nearly 5 times lower in patients with a total tumour size ≥10 cm, and DFS is nearly 2 times lower with a total tumour size ≥9 cm. Based on diameter of the largest tumour nodule the probability of recurrence after LT nearly 6 times higher in patients with diameter of the largest
Journal of Hepatology 2011 vol. 54 | S209–S361
if small (1–2 cm) may be less important for recurrence. Moreover these small nodules are known to be far less likely to be associated with microvascular invasion. The aim of this meta-analysis was to assessed the impact of tumour number on overall survival (OS), disease-free survival (DFS) and recurrence after LT for HCC. Material and methods: MEDLINE, Cochrane Controlled trial Register (CENTRAL), EMBASE and Science Citation Index databases were searched until April 2010. Results: Fifteen studies (4575 patients) evaluating the impact of tumour nodule number on OS, DFS and recurrence after LT were included: 5 studies (719 patients) reporting nodule number it as a continuous variable (HR for OS 1.09; 95% CI 0.88–1.34, HR for recurrence 1.07; 95% CI 0.93–1.23); 3 studies (468 patients) reporting multiple versus single nodules (HR for OS 1.23; 95% CI 1– 1.53); 7 studies (3289 patients) reporting it as cut-offs (3 nodules) (HR for OS 1.29; 95% CI 1.14–1.46, HR for DFS 1.24; 95% CI 0.77–2.01, HR for recurrence 1.02; 95% CI 0.25–4.24). Conclusions: The number of tumours evaluated as a continuous variable does not appear to have a clear impact on overall survival nor on recurrence. Multiple tumours double the risk of recurrence after LT compared to single tumour, but the impact of multiple tumours on OS is borderline. Patients with ≥3 tumours have an increased risk of death compared to those with <3 tumours. The best data based on a precise evaluation of the number of nodules suggests the relationship to recurrence and survival is not statistically significant suggesting that expansion of selection criteria can include an increased number of nodules, but the cut-off for maximum nodule size cannot be derived. 633 TUMOUR SIZE OF HCC AND ITS RELATIONSHIP TO OUTCOME AFTER LIVER TRANSPLANTATION G. Germani1 , M. Garcovich1 , K. Gurusamy2 , C. Toso3 , G. Fede1 , E. Tsochatzis1 , A.K. Burroughs1 . 1 The Royal Free Sheila Sherlock Liver Centre and Division of Surgery, University College London, 2 Hepato-Pancreatico-Biliary and Liver Transplant Unit, University Department of Surgery, Royal Free Campus, UCL Medical School, London, UK; 3 Services de Chirurgie Viscerale et Transplantation Hopitaux Universites de Geneve, Geneva, Switzerland E-mail: [email protected] Background and Aim: The aim of this meta-analysis was to assessed the impact of tumour size on overall survival (OS), diseasefree survival (DFS) and recurrence after LT for HCC. Material and methods: MEDLINE, Cochrane Controlled trial Register (CENTRAL), EMBASE and Science Citation Index databases were searched until April 2010. Results: Thirty-two studies evaluating the impact of tumour size on overall survival (OS), disease-free survival (DFS) and recurrence after LT were included. Total tumour size was evaluated in 7 studies (1502 patients): as continuous variable in 2 studies (HR for recurrence 1.19, 95% CI 0.95–1.49), as a cut-off of 10 cm in 3 studies (HR for OS 4.59, 95% CI 1.26–16.79), and as a cut-off of 9 cm in 2 studies (HR for DFS 1.98; 95% CI 1.49–2.64). The diameter of the largest tumour was evaluated in 9 studies (2743 patients): as a continuous variable in 3 studies (HR for recurrence 1.03; 95% CI 0.99–1.07), as a cut-off of 3 cm in 6 studies (HR for OS ≥3 cm 1.55; 95% CI 1.29–1.86, HR for recurrence 6.69; 95% CI 2.34–19.12). Tumour size without any other specification was assessed in 19 studies (2497 patients): as a continuous variable in 4 studies (HR for OS 1.14; 95% CI 1–1.30), as a cut-off (5 cm) in 16 studies (HR for OS 1.92; 95% CI 1.48–2.50, HR for DFS 4.30; 95% CI 2.48–7.49, HR for recurrence 2.56; 95% CI 1.53–3.34). Conclusions: Considering total tumour size OS is nearly 5 times lower in patients with a total tumour size ≥10 cm, and DFS is nearly 2 times lower with a total tumour size ≥9 cm. Based on diameter of the largest tumour nodule the probability of recurrence after LT nearly 6 times higher in patients with diameter of the largest
Journal of Hepatology 2011 vol. 54 | S209–S361