Hans-Christian Pommergaard1, Andreas A Rostved2, René Adam3, Lau C Thygesen4, Mauro Salizzoni5, Miguel A Gómez Bravo6, Daniel Cherqui3, Franco Filipponi7, Karim Boudjema8, Vincenzo Mazzaferro9, Olivier Soubrane10, Juan C García-Valdecasas11, Joan F Prous12, Antonio D Pinna13, John O'Grady14, Vincent Karam3, Christophe Duvoux15, Allan Rasmussen2. 1. Department of Surgical Gastroenterology and Transplantation, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. Electronic address: HCPommergaard@gmail.com. 2. Department of Surgical Gastroenterology and Transplantation, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. 3. Department of Hepatobiliary Surgery, Cancer and Transplantation, AP-HP, Hôpital Universitaire Paul Brousse, Inserm U 935, Univ Paris-Sud, Villejuif, France. 4. National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark. 5. Liver Transplant Center and General Surgery, A.O.U. Città della Salute e della Scienza di Torino, Molinette Hospital, Turin, Italy. 6. Department of Surgery - Liver Transplant Unit, Hospital Virgen Del Rocio, Sevilla, Spain. 7. Hepatobiliary Surgery and Liver Transplantation Unit, University of Pisa Medical School Hospital, 56124, Pisa, Italy. 8. Service de Chirurgie Hépatobiliaire et Digestive, Hôpital Pontchaillou, Centre Hospitalier Université de Rennes 1, Rennes, France. 9. University of Milan and Division of Gastrointestinal Surgery and Liver Transplantataion, Istituto Nazionale Tumori, Fondazione IRCCS, Milan, Italy. 10. Department of HPB Surgery and Liver Transplant, Beaujon Hospital, Clichy, University Denis Diderot, Paris, France. 11. Hepatobiliopancreatic & Transplant Surgery, ICMDiM, Hospital Clínic, Barcelona, Spain. 12. Unitat de Cirurgia Hepato-bilio-pancreàtica, Hospital Universitari de Bellvitge, Barcelona, Spain. 13. General Surgery and Transplant Division, S. Orsola Hospital, University of Bologna, Bologna, Italy. 14. Institute of Liver Studies, King's College Hospital, London, United Kingdom. 15. Department of Hepatology and Liver Transplant Unit, Henri Mondor Hospital, Paris Est University (UPEC), Créteil, France.
Abstract
BACKGROUND: Studies suggest that vascular invasion may be a superior prognostic marker compared with traditional selection criteria, e.g. Milan criteria. This study aimed to investigate the prognostic value of micro and macrovascular invasion in a large database material. METHODS: Patients liver transplanted for HCC and cirrhosis registered in the European Liver Transplant Registry (ELTR) database were included. The association between the Milan criteria, Up-to-seven criteria and vascular invasion with overall survival and HCC specific survival was investigated with univariate and multivariate Cox regression analyses. RESULTS: Of 23,124 patients transplanted for HCC, 9324 had cirrhosis and data on explant pathology. Patients without microvascular invasion, regardless of number and size of HCC nodules, had a five-year overall survival of 73.2%, which was comparable with patients inside both Milan and Up-to-seven criteria. Patients without macrovascular invasion had an only marginally reduced survival of 70.7% after five years. Patients outside both Milan and Up-to-seven criteria without micro or macrovascular invasion still had a five-year overall survival of 65.8%. CONCLUSION: Vascular invasion as a prognostic indicator remains superior to criteria based on size and number of nodules. With continuously improving imaging studies, microvascular invasion may be used for selecting patients for transplantation in the future.
BACKGROUND: Studies suggest that vascular invasion may be a superior prognostic marker compared with traditional selection criteria, e.g. Milan criteria. This study aimed to investigate the prognostic value of micro and macrovascular invasion in a large database material. METHODS:Patients liver transplanted for HCC and cirrhosis registered in the European Liver Transplant Registry (ELTR) database were included. The association between the Milan criteria, Up-to-seven criteria and vascular invasion with overall survival and HCC specific survival was investigated with univariate and multivariate Cox regression analyses. RESULTS: Of 23,124 patients transplanted for HCC, 9324 had cirrhosis and data on explant pathology. Patients without microvascular invasion, regardless of number and size of HCC nodules, had a five-year overall survival of 73.2%, which was comparable with patients inside both Milan and Up-to-seven criteria. Patients without macrovascular invasion had an only marginally reduced survival of 70.7% after five years. Patients outside both Milan and Up-to-seven criteria without micro or macrovascular invasion still had a five-year overall survival of 65.8%. CONCLUSION: Vascular invasion as a prognostic indicator remains superior to criteria based on size and number of nodules. With continuously improving imaging studies, microvascular invasion may be used for selecting patients for transplantation in the future.
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