Outcomes of Liver Transplantation in 490 Patients with Hepatocellular Carcinoma

Validation of a Uniform Staging after Surgical Treatment

Jean Nicolas Vauthey*, Dario Ribero, Eddie K. Abdalla, Sven Jonas, Ankit Bharat, Guido Schumacher, Jan Lerut, William C. Chapman, Alan W. Hemming, Peter Neuhaus

*Corresponding author for this work

Research output: Contribution to journalArticle

62 Citations (Scopus)

Abstract

Background: The aim of this study was to compare the ability of staging systems (American Joint Committee on Cancer/Union Internationale contre le Cancer [AJCC/UICC], Japanese TNM, Pittsburgh, United Network for Organ Sharing [UNOS], Cancer of the Liver Italian Program [CLIP], Japan Integrated Staging [JIS], and Barcelona Clinic Liver Cancer [BCLC]) to predict survival after liver transplantation for hepatocellular carcinoma. Study Design: Four hundred ninety consecutive patients who underwent liver transplantation for hepatocellular carcinoma at 4 centers (1985 to 2005) were identified using a registry (US, Belgium, Germany). End points were overall (OS) and recurrence-free survival (RFS). Survival by stage was compared with the log-rank test. Sequential stage-wise discrimination of each system was evaluated using Cox regression. Results: Three- and 5-year overall survival rates were 71% and 64%, respectively; recurrence-free survival rates were 67% and 61%, respectively. Median followup among 327 living and 308 recurrence-free patients was 40 months. In only three systems-AJCC/UICC, Japanese TNM, and Pittsburgh-were overall and recurrence-free survivals longer for patients with low stage versus more advanced stage. For overall and recurrence-free survivals, sequential stages were different only for AJCC/UICC. In the Japanese TNM system, stages II and I were similar; for Pittsburgh, grades 3 and 2 were similar. For the United Network for Organ Sharing system, stages II and I and stages IVA1 and III were similar. All stages were similar for the Cancer of the Liver Italian Program. For the Japan Integrated Staging, scores 2 and 1 and scores 4 and 3 were similar. In the Barcelona Clinic Liver Cancer, stage D patients had significantly better survival than patients at stage C. Conclusions: The AJCC/UICC staging system provides the best stratification of prognosis for patients undergoing liver transplantation for hepatocellular carcinoma. This confirms previous analyses in patients treated with hepatic resection. The AJCC/UICC staging system should be considered for uniform prediction of outcomes after surgery for hepatocellular carcinoma.

Original languageEnglish (US)
Pages (from-to)1016-1027
Number of pages12
JournalJournal of the American College of Surgeons
Volume204
Issue number5
DOIs
StatePublished - May 1 2007

Fingerprint

Liver Transplantation
Hepatocellular Carcinoma
Liver Neoplasms
Survival
Neoplasms
Recurrence
Neoplasm Staging
Therapeutics
Japan
Survival Rate
Belgium
Germany
Registries
Liver

ASJC Scopus subject areas

  • Surgery

Cite this

Vauthey, Jean Nicolas ; Ribero, Dario ; Abdalla, Eddie K. ; Jonas, Sven ; Bharat, Ankit ; Schumacher, Guido ; Lerut, Jan ; Chapman, William C. ; Hemming, Alan W. ; Neuhaus, Peter. / Outcomes of Liver Transplantation in 490 Patients with Hepatocellular Carcinoma : Validation of a Uniform Staging after Surgical Treatment. In: Journal of the American College of Surgeons. 2007 ; Vol. 204, No. 5. pp. 1016-1027.
@article{200ed9146e46436db2bb1b4b31bc1e0b,
title = "Outcomes of Liver Transplantation in 490 Patients with Hepatocellular Carcinoma: Validation of a Uniform Staging after Surgical Treatment",
abstract = "Background: The aim of this study was to compare the ability of staging systems (American Joint Committee on Cancer/Union Internationale contre le Cancer [AJCC/UICC], Japanese TNM, Pittsburgh, United Network for Organ Sharing [UNOS], Cancer of the Liver Italian Program [CLIP], Japan Integrated Staging [JIS], and Barcelona Clinic Liver Cancer [BCLC]) to predict survival after liver transplantation for hepatocellular carcinoma. Study Design: Four hundred ninety consecutive patients who underwent liver transplantation for hepatocellular carcinoma at 4 centers (1985 to 2005) were identified using a registry (US, Belgium, Germany). End points were overall (OS) and recurrence-free survival (RFS). Survival by stage was compared with the log-rank test. Sequential stage-wise discrimination of each system was evaluated using Cox regression. Results: Three- and 5-year overall survival rates were 71{\%} and 64{\%}, respectively; recurrence-free survival rates were 67{\%} and 61{\%}, respectively. Median followup among 327 living and 308 recurrence-free patients was 40 months. In only three systems-AJCC/UICC, Japanese TNM, and Pittsburgh-were overall and recurrence-free survivals longer for patients with low stage versus more advanced stage. For overall and recurrence-free survivals, sequential stages were different only for AJCC/UICC. In the Japanese TNM system, stages II and I were similar; for Pittsburgh, grades 3 and 2 were similar. For the United Network for Organ Sharing system, stages II and I and stages IVA1 and III were similar. All stages were similar for the Cancer of the Liver Italian Program. For the Japan Integrated Staging, scores 2 and 1 and scores 4 and 3 were similar. In the Barcelona Clinic Liver Cancer, stage D patients had significantly better survival than patients at stage C. Conclusions: The AJCC/UICC staging system provides the best stratification of prognosis for patients undergoing liver transplantation for hepatocellular carcinoma. This confirms previous analyses in patients treated with hepatic resection. The AJCC/UICC staging system should be considered for uniform prediction of outcomes after surgery for hepatocellular carcinoma.",
author = "Vauthey, {Jean Nicolas} and Dario Ribero and Abdalla, {Eddie K.} and Sven Jonas and Ankit Bharat and Guido Schumacher and Jan Lerut and Chapman, {William C.} and Hemming, {Alan W.} and Peter Neuhaus",
year = "2007",
month = "5",
day = "1",
doi = "10.1016/j.jamcollsurg.2006.12.043",
language = "English (US)",
volume = "204",
pages = "1016--1027",
journal = "Journal of the American College of Surgeons",
issn = "1072-7515",
publisher = "Elsevier Inc.",
number = "5",

}

Outcomes of Liver Transplantation in 490 Patients with Hepatocellular Carcinoma : Validation of a Uniform Staging after Surgical Treatment. / Vauthey, Jean Nicolas; Ribero, Dario; Abdalla, Eddie K.; Jonas, Sven; Bharat, Ankit; Schumacher, Guido; Lerut, Jan; Chapman, William C.; Hemming, Alan W.; Neuhaus, Peter.

In: Journal of the American College of Surgeons, Vol. 204, No. 5, 01.05.2007, p. 1016-1027.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Outcomes of Liver Transplantation in 490 Patients with Hepatocellular Carcinoma

T2 - Validation of a Uniform Staging after Surgical Treatment

AU - Vauthey, Jean Nicolas

AU - Ribero, Dario

AU - Abdalla, Eddie K.

AU - Jonas, Sven

AU - Bharat, Ankit

AU - Schumacher, Guido

AU - Lerut, Jan

AU - Chapman, William C.

AU - Hemming, Alan W.

AU - Neuhaus, Peter

PY - 2007/5/1

Y1 - 2007/5/1

N2 - Background: The aim of this study was to compare the ability of staging systems (American Joint Committee on Cancer/Union Internationale contre le Cancer [AJCC/UICC], Japanese TNM, Pittsburgh, United Network for Organ Sharing [UNOS], Cancer of the Liver Italian Program [CLIP], Japan Integrated Staging [JIS], and Barcelona Clinic Liver Cancer [BCLC]) to predict survival after liver transplantation for hepatocellular carcinoma. Study Design: Four hundred ninety consecutive patients who underwent liver transplantation for hepatocellular carcinoma at 4 centers (1985 to 2005) were identified using a registry (US, Belgium, Germany). End points were overall (OS) and recurrence-free survival (RFS). Survival by stage was compared with the log-rank test. Sequential stage-wise discrimination of each system was evaluated using Cox regression. Results: Three- and 5-year overall survival rates were 71% and 64%, respectively; recurrence-free survival rates were 67% and 61%, respectively. Median followup among 327 living and 308 recurrence-free patients was 40 months. In only three systems-AJCC/UICC, Japanese TNM, and Pittsburgh-were overall and recurrence-free survivals longer for patients with low stage versus more advanced stage. For overall and recurrence-free survivals, sequential stages were different only for AJCC/UICC. In the Japanese TNM system, stages II and I were similar; for Pittsburgh, grades 3 and 2 were similar. For the United Network for Organ Sharing system, stages II and I and stages IVA1 and III were similar. All stages were similar for the Cancer of the Liver Italian Program. For the Japan Integrated Staging, scores 2 and 1 and scores 4 and 3 were similar. In the Barcelona Clinic Liver Cancer, stage D patients had significantly better survival than patients at stage C. Conclusions: The AJCC/UICC staging system provides the best stratification of prognosis for patients undergoing liver transplantation for hepatocellular carcinoma. This confirms previous analyses in patients treated with hepatic resection. The AJCC/UICC staging system should be considered for uniform prediction of outcomes after surgery for hepatocellular carcinoma.

AB - Background: The aim of this study was to compare the ability of staging systems (American Joint Committee on Cancer/Union Internationale contre le Cancer [AJCC/UICC], Japanese TNM, Pittsburgh, United Network for Organ Sharing [UNOS], Cancer of the Liver Italian Program [CLIP], Japan Integrated Staging [JIS], and Barcelona Clinic Liver Cancer [BCLC]) to predict survival after liver transplantation for hepatocellular carcinoma. Study Design: Four hundred ninety consecutive patients who underwent liver transplantation for hepatocellular carcinoma at 4 centers (1985 to 2005) were identified using a registry (US, Belgium, Germany). End points were overall (OS) and recurrence-free survival (RFS). Survival by stage was compared with the log-rank test. Sequential stage-wise discrimination of each system was evaluated using Cox regression. Results: Three- and 5-year overall survival rates were 71% and 64%, respectively; recurrence-free survival rates were 67% and 61%, respectively. Median followup among 327 living and 308 recurrence-free patients was 40 months. In only three systems-AJCC/UICC, Japanese TNM, and Pittsburgh-were overall and recurrence-free survivals longer for patients with low stage versus more advanced stage. For overall and recurrence-free survivals, sequential stages were different only for AJCC/UICC. In the Japanese TNM system, stages II and I were similar; for Pittsburgh, grades 3 and 2 were similar. For the United Network for Organ Sharing system, stages II and I and stages IVA1 and III were similar. All stages were similar for the Cancer of the Liver Italian Program. For the Japan Integrated Staging, scores 2 and 1 and scores 4 and 3 were similar. In the Barcelona Clinic Liver Cancer, stage D patients had significantly better survival than patients at stage C. Conclusions: The AJCC/UICC staging system provides the best stratification of prognosis for patients undergoing liver transplantation for hepatocellular carcinoma. This confirms previous analyses in patients treated with hepatic resection. The AJCC/UICC staging system should be considered for uniform prediction of outcomes after surgery for hepatocellular carcinoma.

UR - http://www.scopus.com/inward/record.url?scp=34247528896&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=34247528896&partnerID=8YFLogxK

U2 - 10.1016/j.jamcollsurg.2006.12.043

DO - 10.1016/j.jamcollsurg.2006.12.043

M3 - Article

VL - 204

SP - 1016

EP - 1027

JO - Journal of the American College of Surgeons

JF - Journal of the American College of Surgeons

SN - 1072-7515

IS - 5

ER -