The results of liver transplantation performed in a single center due to hepatocellular carcinoma

Year 2023, , 169 - 174, 22.06.2023

Serdar Aslan , Şerafettin Yazar , Ahmet Kargı , Eray Kurnaz , Dilek Şahin , Kemal Peker , Ibrahim Astarcioglu , Kamil Polat

https://doi.org/10.18521/ktd.1201669

Abstract

Objective: Hepatocellular cancer (HCC) is the most common malignancy of the hepatobiliary system. There are significant differences in the global spread of HCC. It is the major cause of death in patients with cirrhosis. Its molecular pathogenesis is highly complex and heterogeneous. Major risk factors for the development of HCC are chronic hepatitis B virus (HBV) infection, chronic hepatitis C virus (HCV) infection and alcohol-related liver cirrhosis. Hepatocellular cancer is rarely seen in the first 4 decades of life, except in communities where HBV infection is hyperendemic.
Method: The study was conducted by retrospectively scanning the files of 204 patients diagnosed with HCC who applied to Organ Transplantation Center between 21.09.2014 and 13.04.2019. Patients were transplanted liver by being classified according to Milan criteria, San Francisco [University of California San Francisco (UCSF)] criteria, and Barcelona Clinic Liver Cancer (BCLC) criteria.
Result: The median age of the patients was 58.03 (range 31 to 72). 170 of the patients were men and 34 of them were female. Liver transplantation was performed from cadaveric donors to 31 patients and from living donors to 173 patients. There is a significant relationship between the life span of the patients and their gender. Female patients have a longer life expectancy [t (202) = 2,963, p =, 003]. A significant relationship was found between life expectancy and surgical classification [F (3) = 3,008, (p =, 031)].
Conclusion: In patients diagnosed with HCC and undergoing liver transplantation; the gender being female and the classification method before transplantation affect life expectancy.

Keywords

Transplantation, Liver, Hepatocellular carcinoma

Hepatosellüler kanser nedeniyle tek merkezde yapılan karaciğer nakli sonuçları

Abstract

Amaç: Hepatosellüler kanser (HSK), hepatobiliyer sistemin en sık görülen malignitesidir. HSK'nin küresel yayılımında önemli farklılıklar vardır. Sirozlu hastalarda en önemli ölüm nedenidir. Moleküler patogenezi oldukça karmaşık ve heterojendir. HSK gelişimi için başlıca risk faktörleri kronik hepatit B virüsü (HBV) enfeksiyonu, kronik hepatit C virüsü (HCV) enfeksiyonu ve alkole bağlı karaciğer sirozudur. HSK, HBV enfeksiyonunun hiperendemik olduğu bölgeler dışında, genellikle hayatın ilk dört dekadı içerisinde görülmez.
Metod: Çalışma, 21.09.2014-13.04.2019 tarihleri arasında organ nakli merkezine başvuran HSK tanılı 204 hastanın dosyaları geriye dönük olarak taranarak gerçekleştirildi. Hastalara Milan kriterlerine, San Francisco [University of California San Francisco (UCSF)] kriterlerine ve Barcelona Clinic Liver Cancer (BCLC) kriterlerine göre sınıflandırılarak karaciğer nakli yapıldı.
Bulgular: Hastaların medyan yaşı 58.03 (31-72 aralığında) idi. Hastaların 170'i erkek, 34'ü kadındı. Kadavra vericisinden 31 hastaya, canlı vericiden ise 173 hastaya karaciğer nakli yapıldı. Hastaların yaşam süreleri ile cinsiyetleri arasında anlamlı bir ilişki olduğu görüldü. Kadın hastaların yaşam beklentisi daha uzundur [t (202) = 2.963, p =0.003]. Yaşam beklentisi ile cerrahi sınıflandırma arasında anlamlı bir ilişki bulundu [F (3) = 3.008, (p =0.031)].
Sonuç: HSK tanılı olup karaciğer nakli yapılan hastalarda; cinsiyetin kadın olması ve nakil öncesi yapılan sınıflandırma yöntemi, yaşam beklentisini etkilemektedir.

Keywords

Transplantasyon, Karaciğer, Hepatosellüler kanser

References

• Bruix J, Gores GJ, Mazzaferro V. Hepatocellular carcinoma: clinical frontiers and perspectives. Gut. 2014;63(5):844-55.
• 2. Neuveut C, Wei Y, Buendia MA. Mechanisms of HBV-related hepatocarcinogenesis. J Hepatol. 2010;52(4):594-604.
• 3. Guerrieri F, Belloni L, Pediconi N, Levrero M. Molecular mechanisms of HBV-associated hepatocarcinogenesis. Semin Liver Dis. 2013;33(2):147-56.
• 4. Mínguez B, Tovar V, Chiang D, Villanueva A, Llovet JM. Pathogenesis of hepatocellular carcinoma and molecular therapies. Curr Opin Gastroenterol. 2009;25(3):186-94.
• 5. Arzumanyan A, Reis HM, Feitelson MA. Pathogenic mechanisms in HBV-and HCV-associated hepatocellular carcinoma. Nat Rev Cancer. 2013;13(2):123-35.
• 6. Delis SG, Bakoyiannis A, Tassopoulos N, Athanassiou K, Kelekis D, Madariaga J, et al. Hepatic resection for hepatocellular carcinoma exceeding Milan criteria. Surg Oncol 2010;19(4):200-7.
• 7. Poon RT, Fan ST, Wong J. Selection criteria for hepatic resection in patients with large hepatocellular carcinoma larger than 10 cm in diameter. J Am Coll Surg. 2002;194(5):592-602.
• 8. Andreou A, Vauthey JN, Cherqui D, Zimmitti G, Ribero D, Truty MJ, et al. Improved long-term survival after major resection for hepatocellular carcinoma: a multicenter analysis based on a new definition of major hepatectomy. J Gastrointest Surg. 2013;17(1):66-77.
• 9. Forner A, Reig ME, de Lope CR, Bruix J. Current strategy for staging and treatment: the BCLC update and future prospects. Semin Liver Dis. 2010;30(1):61-74.
• 10 Lee KK, Kim DG, Moon IS, Lee MD, Park JH. Liver transplantation versus liver resection for the treatment of hepatocellular carcinoma. J Surg Oncol. 2010;101(1):47-53.
• 11. Cauchy F, Fuks D, Belghiti J. HCC: current surgical treatment concepts. Langenbecks Arch Surg. 2012;397(5):681-95.
• 12. Giuliante F, Ardito F, Pinna AD, Sarno G, Giulini SM, Ercolani G, et al. Liver resection for hepatocellular carcinoma ≤3 cm: results of an Italian multicenter study on 588 patients. J Am Coll Surg. 2012;215(2):244-54.
• 13. Regimbeau JM, Kianmanesh R, Farges O, Dondero F, Sauvanet A, Belghiti J. Extent of liver resection influences the outcome in patients with cirrhosis and small hepatocellular carcinoma. Surgery. 2002;131(3):311-7.
• 14. Kang CM, Choi GH, Kim DH, Choi SB, Kim KS, Choi JS, et al. Revisiting the role of nonanatomic resection of small (< or = 4 cm) and single hepatocellular carcinoma in patients with well-preserved liver function. J Surg Res. 2010;160(1):81-9.
• 15. Ueno S, Sakoda M, Kubo F, Hiwatashi K, Tateno T, Baba Y, et al. Surgical resection versus radiofrequency ablation for small hepatocellular carcinomas within the Milan criteria. J Hepatobiliary Pancreat Surg. 2009;16(3):359-66.
• 16. Akriviadis EA, Llovet JM, Efremidis SC, Shouval D, Canelo R, Ringe B, et al. Hepatocellular carcinoma. Br J Surg. 1998;85(10):1319-31.
• 17. Hanazaki K, Kajikawa S, Shimozawa N, Shimada K, Hiraguri M, Koide N, et al. Hepatic resection for large hepatocellular carcinoma. Am J Surg. 2001;181(4):347-53.
• 18. Shimada M, Takenaka K, Taguchi K, Fujiwara Y, Gion T, Kajiyama K, et al. Prognostic factors after repeat hepatectomy for recurrent hepatocellular carcinoma. Ann Surg. 1998;227(1):80-5.
• 19. Shan YS, Hsieh YH, Lin PW. Telomerase activity in tumor and remnant liver as predictor of recurrence and survival in hepatocellular carcinoma after resection. World J Surg. 2007;31(5):1121-8.
• 20. Morimoto O, Nagano H, Sakon M, Fujiwara Y, Yamada T, Nakagawa H, et al. Diagnosis of intrahepatic metastasis and multicentric carcinogenesis by microsatellite loss of heterozygosity in patients with multiple and recurrent hepatocellular carcinomas. J Hepatol. 2003;39(2):215-21.
• 21. Schwartz JD, Schwartz M, Mandeli J, Sung M. Neoadjuvant and adjuvant therapy for resectable hepatocellular carcinoma: review of the randomised clinical trials. Lancet Oncol. 2002;3(10):593-603.
• 22. Arii S, Yamaoka Y, Futagawa S, Inoue K, Kobayashi K, Kojiro M, et al. Results of surgical and nonsurgical treatment for small-sized hepatocellular carcinomas: a retrospective and nationwide survey in Japan. The Liver Cancer Study Group of Japan. Hepatology. 2000;32(6):1224-9.
• 23. Ishizawa T, Hasegawa K, Aoki T, Takahashi M, Inoue Y, Sano K, et al. Neither multiple tumors nor portal hypertension are surgical contraindications for hepatocellular carcinoma. Gastroenterology. 2008;134(7):1908-16.
• 24. Poon RT, Fan ST, Lo CM, Liu CL, Ng IO, Wong J. Long-term prognosis after resection of hepatocellular carcinoma associated with hepatitis B-related cirrhosis. J Clin Oncol. 2000;18(5):1094-101.
• 25. Dahiya D, Wu TJ, Lee CF, Chan KM, Lee WC, Chen MF. Minor versus major hepatic resection for small hepatocellular carcinoma (HCC) in cirrhotic patients: a 20-year experience. Surgery. 2010;147(5):676-85.
• 26. Clavien PA, Lesurtel M, Bossuyt PM, Gores GJ, Langer B, Perrier A, et al. Recommendations for liver transplantation for hepatocellular carcinoma: an international consensus conference report. Lancet Oncol. 2012;13(1):e11-22.
• 27. Farinati F, Giacomin A, Vanin V, Sergio A, Burra P, Cillo U, et al. Liver transplantation for hepatocellular carcinoma in clinical practice: the lesson from a 20-year multicentre experience in Italy. Eur J Gastroenterol Hepatol. 2012;24(2):195-202.
• 28. Temel T, Bilge U, Harmancı Özakyol A. Retrospective evaluation of patients with hepatocellular carcinoma: single-center experience (in Turkish with English abstract). Konuralp Tıp Dergisi (Tur Konuralp Med J). 2015;7(1):57-60.
• 29. Topal F, Taşdemir Ü, Gümüş ZZ, Günay S, Çamyar H, Akbulut S, et al. Efficacy of P2/MS and AFP in early prediction of hepatocellular carcinoma recurrence. Konuralp Tıp Dergisi. 2020;12(2):223-6.