Incidence of occult intrahepatic metastasis in hepatocellular carcinoma treated with transplantation corresponds to early recurrence rates after partial hepatectomy Journal Article


Authors: Aufhauser, D. D. Jr; Sadot, E.; Murken, D. R.; Eddinger, K.; Hoteit, M.; Abt, P. L.; Goldberg, D. S.; DeMatteo, R. P.; Levine, M. H.
Article Title: Incidence of occult intrahepatic metastasis in hepatocellular carcinoma treated with transplantation corresponds to early recurrence rates after partial hepatectomy
Abstract: Objective: This study aimed to compare the incidence of radiologically unrecognized (occult) hepatocellular carcinoma (HCC) lesions in explant hepatectomy specimens from orthotopic liver transplants (OLTs) performed for HCC with rates of HCC intrahepatic recurrence after resection. Summary of Background Data: Resection of HCC is associated with high rates of intrahepatic HCC recurrence. However, it is unclear whether these recurrences represent incomplete resection of unrecognized metastatic lesions from the primary tumor or subsequent de novo tumor formation due to inherent biological proclivity for HCC formation. Methods: We collected patient, tumor, and pathology data on HCC patients treated surgically from 3696 OLTs in the Organ Procurement and Transplantation (OPTN) national database, 299 OLTs at a single transplant center, and 232 partial hepatectomies from a hepatobiliary cancer center. Results: In the OPTN and high-volume transplant center cohorts, 37% and 42% of patients had occult HCC lesions on explant pathology, respectively. Among cancer center patients, the 2-year recurrence rate was 46%, and 74% of patients who recurred presented with liver only recurrence. Conclusion: Although the transplant and resection populations differ, occult multifocality is common in transplant explants and similar to the 46% early recurrence rate following partial hepatectomy. These data suggest that noncurative resection often results from occult intrahepatic multifocality present at the time of resection rather than a malignant predisposition of the remnant liver with de novo tumorigenesis. © 2017 Wolters Kluwer Health, Inc. All rights reserved.
Keywords: adult; treatment outcome; aged; major clinical study; histopathology; cancer recurrence; hepatocellular carcinoma; liver cell carcinoma; liver cirrhosis; liver transplantation; outcome assessment; recurrence risk; cancer susceptibility; incidence; explant; risk factor; liver metastasis; resection; outcomes; partial hepatectomy; occult cancer; human; male; female; priority journal; article; liver transplant
Journal Title: Annals of Surgery
Volume: 267
Issue: 5
ISSN: 0003-4932
Publisher: Lippincott Williams & Wilkins  
Date Published: 2018-05-01
Start Page: 922
End Page: 928
Language: English
DOI: 10.1097/sla.0000000000002135
PROVIDER: scopus
PMCID: PMC5507755
PUBMED: 28085695
DOI/URL:
Notes: Article -- Export Date: 1 May 2018 -- Source: Scopus
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  1. Ronald P Dematteo
    558 Dematteo