Occult multifocal and incidental hepatocellular carcinoma: An analysis of long-term survival and risk factors at a single liver transplant center

Résumé fourni par la source

The clinical significance of occult HCC identified on explant pathology in liver transplantation (LT) remains unclear. Among recipients of LT, discordance between pre-LT radiographic assessment of HCC and explant tumor burden is common. Data regarding the association of incidental HCC (no pre-LT radiographic diagnosis) and occult multifocal hepatocellular carcinoma (omHCC, pre-LT radiology underestimates a number of explant tumors) with outcomes are scarce. Post-LT recurrence and survival were compared among recipients of LT (n=919, 2002-2019) with incidental HCC (n=129), omHCC (n=349), and non-omHCC (n=437). Multivariable analysis identified independent predictors of omHCC in the subset of patients with kHCC. Compared to kHCC, incidental HCC had similar 5-year overall (OS) and recurrence-free survival (RFS), lower post-LT recurrence (6.9% vs. 16.2%, p =0.0019), but higher non-HCC-related mortality (38.4% vs. 23.7%, p =0.0042). Of 790 kHCC, 349 (44.1%) had omHCC, who demonstrated greater radiographic number of lesions ( p =0.049) and locoregional treatments ( p <0.001) but similar maximum and pre-LT alphafetoprotein compared to non-omHCC. Compared to kHCC without omHCC, patients with omHCC had inferior 5-year OS (60.4% vs. 70.9%, p =0.010) and RFS (56.8% vs. 69.7%, p <0.001), higher recurrence (23.8% vs. 9.2%, p <0.001), and similar non-HCC-related mortality. These observations remained true within patients who remained within Milan throughout preoperative imaging (5-y OS: 62.1% vs. 72.6%, p =0.027; RFS: 58.6% vs. 71.7%, p =0.010; recurrence: 21.7% vs. 7.6%, p <0.001). Multivariable predictors of omHCC tumor included a number of pre-LT locoregional therapies (OR 1.62 for 2 treatments, 95% CI 1.15-2.28, p =0.005; OR 1.98 for 3+ treatments, 1.36-2.88, p <0.001). In patients with kHCC prior to LT, the presence of omHCC is common and associated with inferior post-LT survival and higher recurrence rates. The development of improved radiographic and serum biomarkers that more accurately reflect explant tumor burden may improve patient selection and post-LT outcomes.

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