Occult multifocal and incidental hepatocellular carcinoma: An analysis of long-term survival and risk factors at a single liver transplant center
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Issued Date
2025-01-01
Resource Type
ISSN
15276465
eISSN
15276473
Scopus ID
2-s2.0-105006683020
Pubmed ID
40372118
Journal Title
Liver Transplantation
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SCOPUS
Bibliographic Citation
Liver Transplantation (2025)
Suggested Citation
Amara D., Dumronggittigule W., Melehy A., Markovic D., Nguyen L., Nesbit S., Lu D.S., Ebaid S., Kaldas F.M., Farmer D.G., Busuttil R.W., Agopian V.G. Occult multifocal and incidental hepatocellular carcinoma: An analysis of long-term survival and risk factors at a single liver transplant center. Liver Transplantation (2025). doi:10.1097/LVT.0000000000000640 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/110517
Title
Occult multifocal and incidental hepatocellular carcinoma: An analysis of long-term survival and risk factors at a single liver transplant center
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Corresponding Author(s)
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Abstract
Objective: To evaluate the clinical significance of occult hepatocellular carcinoma (HCC) identified on explant pathology in liver transplantation (LT). Background: Among LT recipients, discordance between pre-LT radiographic assessment of HCC and explant tumor burden is common. Data regarding the association of incidental HCC (iHCC, no pre-LT radiographic diagnosis) and occult multifocal HCC (omHCC, pre-LT radiology underestimates number of explant tumors) with outcomes are scarce. Design/Methods: Post-LT recurrence and survival were compared among LT recipients (n=919, 2002-2019) with iHCC (n=129), omHCC (n=349) and non-omHCC (n=437). Multivariable analysis identified independent predictors of omHCC in the subset of patients with known HCC (kHCC). Results: Compared to kHCC, iHCC had similar 5-yr 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 loco-regional treatments (p<0.001) but similar maximum and pre-LT alphafetoprotein compared to non-omHCC. Compared to kHCC without omHCC, omHCC patients 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-year 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 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). Conclusion: In patients with known HCC prior to LT, presence of omHCC is common and associated with inferior post-LT survival and higher recurrence rates. The development of improved radiographic and serum biomarkers which more accurately reflect explant tumor burden may improve patient selection and post-LT outcomes.