The impact of tumor necrosis on tumor free survival in patients undergoing liver transplant with hepatocellular carcinoma: an analysis using the UNOS liver recipient explant pathology form.
Moonka D, Salgia R, and Harper AM. The impact of tumor necrosis on tumor free survival in patients undergoing liver transplant with hepatocellular carcinoma: an analysis using the UNOS liver recipient explant pathology form. Hepatology 2017; 66:897A-898A.
Background: In previous SRTR analyses, we demonstrated that specific donor factors as well as the donor risk index were associated with tumor free survival in patients undergoing liver transplant (LT) with hepatocellular carcinoma (HCC) In this study, we attempt to identify donor and recipient variables associated with tumor free survival controlling for variables in the UNOS liver recipient explant pathology form Methods: We looked at patients who underwent LT with the HCC exception from April 12, 2012 to Dec 31, 2015 who had explant forms. We excluded patients with cholangiocarcinoma, living donor transplant or death within 3 months. Patients were evaluated for tumor free survival using donor, recipient and explant variables with Kaplan‐Meier (KM) curves with log rank tests. Multivariate modeling was done using competing risks regression analysis. Results: There were 5765 recipients who met inclusion criteria and of these 384 (6.7%) had recurrence. On univarate analysis, variables associated with recurrence that were included in multivariate analysis were tumor outside Milan criteria, vascular invasion, poorly differentiated histology, AFP > 100 at LT, male race, hepatitis C, recipient CMV, longer waiting time and incomplete or no necrosis in patients who underwent locoregional therapy. On multivariate analysis, only tumor outside Milan (HR 2.20: CI 1.98‐2.41: P<0.0oi), vasc invasion (HR 2.33: CI 2.10‐2.56: P<0.001), poorly diff histology (HR 2.46: CI 2.20‐2.73: P<0.001), AFP >100 at LT (HR 2.07: CI 1.81‐2.32: P<0.001) and incomplete (HR 1.37: CI 1.07‐1.68: P=0.042) and no necrosis (HR 1.51: CI 1.13‐1.89: P=0.032) were associated with decreased tumor free survival 5221 patients were treated prior to transplant. 1349 (23%) had complete necrosis, 2681 (46.5%) had incomplete and 816 (14.2%) had no necrosis. Patients with complete necrosis had 1 and 3 year recurrence free survival of 98 5% and 96 8% compared to 94 9% and 88 9% for patients with incomplete necrosis and 96 8 and 91 3% with no necrosis The difference was significant (P<0.001). The difference was even greater for patients with tumor outside Milan Criteria on explant Patients with complete necosis had 1 and 3 year recurrence free survival of 97 0 and 96 5% vs 91 1 and 81 8% for incomplete necrosis and 91 5% and 78.3% for no necrosis (P<0.001). Conclusions: Outside of recipient explant pathology, no donor or recipient factors were identified that associated with tunor free survival. In patients who underwent pre‐LT therapy, incomplete or no necrosis was associated with decreased tumor free survival and the effect was more pronounced for patients with tumor outside Milan ciriteria.