Survival after liver transplantation in patients with hepatocellular carcinoma.

During a 12-year period (1981-1992), 3,029 patients, including 220 with hepatocellular carcinoma (HCC), received their first orthotopic liver transplantation (OLTX) for various liver diseases. One-, three- and five-year survivals of these 220 patients with HCC were 68%, 46%, and 37%, respectively, and those of the 2,809 patients without HCC were 78%, 71%, and 67.0%, respectively. Among the 220 patients with HCC, the following factors were associated with a poor prognosis: multiple tumors, HCC in two lobes of the liver ("bilobar tumors"), micro- and macroscopic vascular invasion, lymph node metastasis, tumor within the surgical margin, Stage IV HCC, and male gender. Cirrhosis and detection of hepatitis B surface antigen (HBsAg) or antibody to hepatitis C virus (anti-HCV) did not influence the survival rates after OLTX in the presence of HCC. By multivariate analysis, the negative prognostic value of only vascular invasion, bilobar distribution, and lymph node metastasis reached significance. As vascular invasion of HCC was the most significant prognostic factor after OLTX, its incidence was examined according to the following three radiologic measurements of the HCC before operation: (1) size, (2) lobar distribution, and (3) number of HCC nodules. Fifty percent of the HCCs of greater than 5 cm diameter had macroscopic vascular invasion, and 1-, 3- and 5-year survivals of the patients with these HCCs were 60%, 30%, and 18%, respectively, after OLTX. Nearly 50% of the bilobar HCCs also had macroscopic vascular invasion, and 1-, 3- and 5-year survivals were 56%, 29%, and 15%, respectively, after OLTX. One-third of multiple tumors had macroscopic vascular invasion, and 1-, 3- and 5-year survivals were 64%, 38%, and 27%, respectively. However, survival after OLTX in patients with bilobar HCCs of < or = 2 cm diameter (even when these were Stage IV) was as good as in patients without HCC who had OLTX. The 5-year survival rate of the patients with unilobar, multiple HCCs without macroscopic vascular invasion, lymph node invasion and distant metastasis was 60%. These data indicate that HCCs of up to 5 cm diameter without macroscopic vascular invasion and nodal or distant metastasis can be effectively treated by OLTX.