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Liver transplantation for hepatocellular carcinoma: A proposal of a prognostic scoring system

Iwatsuki, S and Dvorchik, I and Marsh, JW and Madariaga, JR and Carr, B and Fung, JJ and Starzl, TE (2000) Liver transplantation for hepatocellular carcinoma: A proposal of a prognostic scoring system. Journal of the American College of Surgeons, 191 (4). 389 - 394. ISSN 1072-7515

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Background: The current staging system of hepatocellular carcinoma established by the International Union Against Cancer and the American Joint Committee on Cancer does not necessarily predict the outcomes after hepatic resection or transplantation. Study Design: Various clinical and pathologic risk factors for tumor recurrence were examined on 344 consecutive patients who received hepatic transplantation in the presence of nonfibrolamellar hepatocellular carcinoma to establish a reliable risk scoring system. Results: Multivariate analysis identified three factors as independently significant poor prognosticators: 1) bilobarly distributed tumors, 2) size of the greatest tumor (2 to 5 cm and > 5 cm), and 3) vascular invasion (microscopic and macroscopic). Prognostic risk score (PRS) of each patient was calculated from the relative risks of multivariate analysis. The patients were grouped into five grades of tumor recurrence risk: grade 1: PRS = 0 to < 7.5; grade 2: PRS = 7.5 to ≤ 11.0; grade 3: PRS > 11.0 to 15.0; grade 4: PRS ≥ 15.0; and grade 5: positive node, metastasis, or margin. The proposed PRS system correlated extremely well with tumor-free survival after liver transplantation (100%, 61%, 40%, 5%, and 0%, from grades 1 to 5, respectively, at 5 years), but current pTNM staging did not. Conclusions: 1) Patients with grades 1 and 2 are effectively treated with liver transplantation, 2) patients with grades 4 and 5 are poor candidates for liver transplantation, and 3) patients with grade 1 do not benefit from adjuvant chemotherapy. (C) 2000 by the American College of Surgeons.


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Item Type: Article
Status: Published
CreatorsEmailPitt UsernameORCID
Iwatsuki, S
Dvorchik, I
Marsh, JW
Madariaga, JR
Carr, B
Fung, JJ
Starzl, TEtes11@pitt.eduTES11
Centers: Other Centers, Institutes, Offices, or Units > Thomas E. Starzl Transplantation Institute
Date: 19 October 2000
Date Type: Publication
Journal or Publication Title: Journal of the American College of Surgeons
Volume: 191
Number: 4
Page Range: 389 - 394
DOI or Unique Handle: 10.1016/s1072-7515(00)00688-8
Institution: University of Pittsburgh
Refereed: Yes
ISSN: 1072-7515
Other ID: uls-drl:31735062120583, Starzl CV No. 2150
Date Deposited: 08 Apr 2010 17:36
Last Modified: 05 Feb 2019 11:55


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