Do Tumor Characteristics and Pre-Transplant Locoregional Therapy Predict Survival after OLT in Patients with
Hepatocellular Carcinoma?
30
mor size did not influence survival post-OLT in patients
within Milan criteria [30] compared to those who did not
have TACE.
However, these findings were not shown to be signifi-
cant on univariate analysis, probably because the sample
size was too small. Accordingly, we do not have enough
numbers of patients who survived long enough to show
any statistically significant difference.
Tumor burden and biological behavior:
We assumed that those having well differentiated HCC
might have a better outcome than those having poorly or
moderately differentiated HCC. This was based on a dif-
ferent biological behavior and a tendency to metastasize.
In the univariate analysis, those who had complete ne-
crosis by locoregional therapy at explant were not in-
cluded in this analysis, because the pathologist could not
determine the degree of differentiation. The group having
well differentiated HCC had a trend for better survival.
This variable needs to be studied on a larger number of
patients with longer follow-up periods using death from
metastatic HCC as an end point, excluding all other caus-
es of mortality to minimize confounding factors. As pre-
viously stated in this context, identification of the degree
of differentiation of HCC at the explant is liable to inter-
personal and even intrapersonal variations. This is a po-
tential weakness in all retrospective studies having ex-
plant specimens examined by more than one pathologist
over a relatively long duration of time.
When we tested those having complete necrosis at ex-
plant independently in univariate analysis having the
same assumption of probable better survival by decreas-
ing tumor burden, we did not find any statistically sig-
nificant difference. There was no way to make certain
whether all of this necrotic tissue was tumor tissue, or
some of the surrounding liver tissue which was acciden-
tally targeted by less selective locoregional techniques.
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