The characteristics and risk factors of tumor recurrence and metastasis in patients of hepatocellular carcinoma after liver transplantation

Objective To explore the characteristics of tumor recurrence and metastasis in patients of hepatocellular carcinoma(HCC) after liver transplantation(LT),including sites,time and risk factors of recurrence.Methods Preoperative,intraoperative and postoperative data of consecutive 99 cases of HCC received LT were collected from January 1,2005 to December 31,2006.Seven cases of death were excluded in period of hospitalization.Then regular follow-up were performed,another 6 cases were excluded including 5 cases dead of no recurrence and 1 case dropped off without recurrence.The remnant 86 cases were followed up for 12 to 35 months.Tumor recurred and metastasis in 38 cases.Risk factors were analyzed using SPSS statistic software between recurrent group and no-recurrent group.Results The number of tumor were more and the largest tumor size were bigger in recurrence group than that in no-recurrence group.Preoperative level of alpha-fetoprotein(AFP)400ng/ml,exceeding Milan-criteria,pTNM staging being pT3 or pT4,and vascular invasion were risk factors for tumor recurrence.Multivariate analysis demonstrated that pTNM staging being pT3 or pT4 was independent risk factor for tumor recurrence after LT.The vascular invasion was risk factor for tumor recurrence after LT in short period.Conclusion Tumorrecurrence and metastasis occurred more outside the liver at first after LT.Large HCC had characteristics of understaging and vascular invasion,and they recurred early.The pTNM staging being pT3 or pT4 were major risk factors for tumor recurrence.Vascular invasion resulted in tumor recurrence in short period.