Hans-Christian Pommergaard1, Andreas Arendtsen Rostved1, René Adam2, Allan Rasmussen1, Mauro Salizzoni3, Miguel Angel Gómez Bravo4, Daniel Cherqui2, Paolo De Simone5, Pauline Houssel-Debry6, Vincenzo Mazzaferro7, Olivier Soubrane8, Juan Carlos García-Valdecasas9, Joan Fabregat Prous10, Antonio D Pinna11, John O'Grady12, Vincent Karam2, Christophe Duvoux13, Lau Caspar Thygesen14. 1. Department of Surgical Gastroenterology and Transplantation, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. 2. Department of Hepatobiliary Surgery, Cancer, and Transplantation, AP-HP, Hôpital Universitaire Paul Brousse, Inserm U935, Université Paris-Sud, Villejuif, France. 3. Liver Transplant Centre and General Surgery, A.O.U. Città della Salute e della Scienza di Torino, Molinette Hospital, Turin, Italy. 4. Liver Transplant Unit, Department of Surgery, Hospital Virgen del Rocio, Sevilla, Spain. 5. Hepatobiliary Surgery and Liver Transplantation Unit, University of Pisa Medical School Hospital, Pisa, Italy. 6. Service de Chirurgie Hépatobiliaire et Digestive, Hôpital Pontchaillou, Centre Hospitalier Université de Rennes 1, and INSERM, UMR991, Foie, Métabolisme et Cancer, Université de Rennes 1, Rennes, France. 7. University of Milan and Division of Gastrointestinal Surgery and Liver Transplantation, Istituto Nazionale Tumori, Fondazione IRCCS, Milan, Italy. 8. Department of HPB Surgery and Liver Transplant, Beaujon Hospital, Clichy, University Denis Diderot, Paris, France. 9. Hepatobiliopancreatic and Transplant Surgery, ICMDiM, Hospital Clínic, Barcelona, Spain. 10. Unitat de Cirurgia Hepato-bilio-pancreàtica, Hospital Universitari de Bellvitge, Barcelona, Spain. 11. General Surgery and Transplant Division, S. Orsola Hospital, University of Bologna, Bologna, Italy. 12. Institute of Liver Studies, King's College Hospital, London, United Kingdom. 13. Department of Hepatology and Liver Transplant Unit, Henri Mondor Hospital, Paris Est University, Créteil, France. 14. National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
Abstract
Background and Aims: Prognosis after liver transplantation differs between hepatocellular carcinoma (HCC) arising in cirrhotic and non-cirrhotic livers and aetiology is poorly understood. The aim was to investigate differences in mortality after liver transplantation between these patients. Methods: We included patients from the European Liver Transplant Registry transplanted due to HCC from 1990 to November 2016 and compared cirrhotic and non-cirrhotic patients using propensity score (PS) calibration of Cox regression estimates to adjust for unmeasured confounding. Results: We included 22,787 patients, of whom 96.5% had cirrhosis. In the unadjusted analysis, non-cirrhotic patients had an increased risk of overall mortality with a hazard ratio (HR) of 1.37 (95% confidence interval [CI] 1.23-1.52). However, the HR approached unity with increasing adjustment and was 1.11 (95% CI 0.99-1.25) when adjusted for unmeasured confounding. Unadjusted, non-cirrhotic patients had an increased risk of HCC-specific mortality (HR 2.62, 95% CI 2.21-3.12). After adjustment for unmeasured confounding, the risk remained significantly increased (HR 1.62, 95% CI 1.31-2.00). Conclusions: Using PS calibration, we showed that HCC in non-cirrhotic liver has similar overall mortality, but higher HCC-specific mortality. This may be a result of a more aggressive cancer form in the non-cirrhotic liver as higher mortality could not be explained by tumour characteristics or other prognostic variables.
Background and Aims: Prognosis after liver transplantation differs between hepatocellular carcinoma (HCC) arising in cirrhotic and non-cirrhotic livers and aetiology is poorly understood. The aim was to investigate differences in mortality after liver transplantation between these patients. Methods: We included patients from the European Liver Transplant Registry transplanted due to HCC from 1990 to November 2016 and compared cirrhotic and non-cirrhotic patients using propensity score (PS) calibration of Cox regression estimates to adjust for unmeasured confounding. Results: We included 22,787 patients, of whom 96.5% had cirrhosis. In the unadjusted analysis, non-cirrhotic patients had an increased risk of overall mortality with a hazard ratio (HR) of 1.37 (95% confidence interval [CI] 1.23-1.52). However, the HR approached unity with increasing adjustment and was 1.11 (95% CI 0.99-1.25) when adjusted for unmeasured confounding. Unadjusted, non-cirrhotic patients had an increased risk of HCC-specific mortality (HR 2.62, 95% CI 2.21-3.12). After adjustment for unmeasured confounding, the risk remained significantly increased (HR 1.62, 95% CI 1.31-2.00). Conclusions: Using PS calibration, we showed that HCC in non-cirrhotic liver has similar overall mortality, but higher HCC-specific mortality. This may be a result of a more aggressive cancer form in the non-cirrhotic liver as higher mortality could not be explained by tumour characteristics or other prognostic variables.
Authors: Hans-Christian Pommergaard; Andreas A Rostved; René Adam; Lau C Thygesen; Mauro Salizzoni; Miguel A Gómez Bravo; Daniel Cherqui; Franco Filipponi; Karim Boudjema; Vincenzo Mazzaferro; Olivier Soubrane; Juan C García-Valdecasas; Joan F Prous; Antonio D Pinna; John O'Grady; Vincent Karam; Christophe Duvoux; Allan Rasmussen Journal: HPB (Oxford) Date: 2018-04-03 Impact factor: 3.647
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