Comparison of Two Staging Systems for Hepatocellular Carcinoma in Post-Transplant Liver Patients.
Monica Garcia-Buitrago, Pablo Bejarano. University of Miami/Jackson Memorial Hospital, FL
Background: Several staging systems have been used to predict prognosis and guide therapeutic approach for hepatocellular carcinoma (HCC). Current treatment options include resection and transplantation. The United Network for Organ Sharing organization uses the modified staging American Liver Study Group (ALTSG) to allocate donor livers to patients with HCC who require transplantation. The best staging system remains controversial. The aim of this study is to compare the American Joint Committee on Cancer (AJCC) and ALTSG staging systems.
Design: A search for HCC patients who underwent liver transplant over a 6-year-period was performed. The pathology reports and histology slides of the native livers were reviewed to assess number of tumors, tumor size, lymphovascular and portal invasion. The cases were re-staged using AJCC and ALTSG systems. Survival and recurrence data were collected.
Results: Liver transplantation for HCC was performed in 203 patients (155M, 48F) with a mean age of 58 years (range 29-77). The average follow-up was 29 months (range 0.5-76). Using the AJCC, 43% of patients were stage I, 51% stage II and 6% stage III. Using the MSALTSG, 16% of the patients were stage I, 53% stage II, 18% stage III and 14% stage IV. The overall survival at AJCC and ALTSG stages I-II was 30 and 31 months, respectively. The overall survival at AJCC and ALTSG stages III-IV was 15 and 26 months (p<0.02). Recurrence rate at AJCC stages I, II and III are 2%, 10% and 33%, respectively. Recurrence rate at ALTSG stages I, II, III and IV are 3%, 5%, 14% and 18, respectively.
Conclusions: Among the two systems, the AJCC showed better stratification of patients when evaluating the overall survival. However, ALTSG showed better discrimination of recurrence rate. While further studies are performed to establish the ideal staging system in transplanted patients with HCC, we strongly recommend the use of both systems in the synoptic reports.
Category: Quality Assurance
Monday, February 28, 2011 1:00 PM
Poster Session II # 217, Monday Afternoon