Department of Hepatology and Liver Transplantation, Reina Sofía University Hospital, Córdoba, Spain.
Maimónides Institute of Biomedical Research of Córdoba (IMIBIC), Córdoba, Spain.
PLoS One. 2017 Apr 12;12(4):e0175010. doi: 10.1371/journal.pone.0175010. eCollection 2017.
Incidental hepatocellular carcinoma (iHCC) is a histological finding after liver transplantation (LT) which relevance has been scarcely studied.
to describe the histopathological features of iHCC and to determine its prognostic impact in terms of tumor recurrence and overall survival.
Observational study including 451 consecutive adult LT patients (2000-2013). Patients aged<18, retransplanted or with early postoperative death were excluded. Median follow-up after LT was 58 months. Multiple Cox's regression was used to assess the prognostic impact of iHCC on tumor recurrence and mortality while controlling for potential confounders.
141 patients had known HCC before LT (31.3%). Among the remaining 310 patients, the prevalence of iHCC was 8.7% (n = 27). In the explanted liver, 36.2% of patients with known HCC and 25.9% of patients with iHCC trespassed Milan criteria (p = 0.30). Patients with known and iHCC had similar rates of multinodular disease (50.4% vs 55.6%; p = 0.62), macrovascular invasion (6.5% vs 3.7%; p = 0.58), microvascular invasion (12.9% vs 14.8%; p = 0.76) and moderate-poor tumor differentiation (53.9% vs 70.4%; p = 0.09). In the multivariate analysis, iHCC and known HCC had identical recurrence-free survival after controlling for histological features (RR = 1.06, 95%CI 0.36-3.14; p = 0.90). Cumulative 5-year overall survival rates were similar between patients with known and iHCC (65% vs 52.8% respectively; log rank p = 0.44), but significantly inferior as compared with patients without HCC (77.8%) (p = 0.002 and p = 0.007 respectively). Indeed, in the overall cohort, iHCC was an independent predictor of mortality (RR = 3.02; 95%CI 1.62-5.65; p = 0.001).
The risk of tumor recurrence after LT is similar in patients with iHCC and known HCC. A close imaging surveillance is strongly recommended for patients awaiting LT in order to detect HCC prior to LT, thus allowing for an adequate selection of candidates, prioritization and indication of bridging therapies.
偶然发现的肝细胞癌（iHCC）是肝移植（LT）后的组织学发现，其相关性尚未得到充分研究。
描述 iHCC 的组织病理学特征，并确定其在肿瘤复发和总体生存方面的预后影响。
这项包括 451 例连续成年 LT 患者（2000-2013 年）的观察性研究排除了年龄<18 岁、再次移植或术后早期死亡的患者。LT 后的中位随访时间为 58 个月。多变量 Cox 回归用于评估 iHCC 对肿瘤复发和死亡率的预后影响，同时控制潜在的混杂因素。
141 例患者在 LT 前已知患有 HCC（31.3%）。在其余 310 例患者中，iHCC 的患病率为 8.7%（n=27）。在切除的肝脏中，已知 HCC 患者中有 36.2%和 iHCC 患者中有 25.9%超出米兰标准（p=0.30）。已知 HCC 患者和 iHCC 患者的多结节疾病发生率相似（50.4%比 55.6%；p=0.62），大血管侵犯率（6.5%比 3.7%；p=0.58），微血管侵犯率（12.9%比 14.8%；p=0.76）和中-低肿瘤分化率（53.9%比 70.4%；p=0.09）。在多变量分析中，在控制组织学特征后，iHCC 和已知 HCC 的无复发生存率相同（RR=1.06，95%CI 0.36-3.14；p=0.90）。已知 HCC 患者和 iHCC 患者的 5 年累积总生存率相似（分别为 65%和 52.8%；对数秩检验 p=0.44），但明显低于无 HCC 患者（77.8%）（p=0.002 和 p=0.007）。事实上，在整个队列中，iHCC 是死亡率的独立预测因素（RR=3.02；95%CI 1.62-5.65；p=0.001）。
iHCC 患者 LT 后肿瘤复发的风险与已知 HCC 患者相似。强烈建议等待 LT 的患者进行密切的影像学监测，以便在 LT 前检测到 HCC，从而能够对候选者进行适当的选择、优先排序和桥接治疗的指示。
