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Liver transplantation for hepatocellular carcinoma: analysis of survival according to the intention-to-treat principle and dropout from the waiting list.
Liver Transpl. 2002 Oct; 8(10):873-83.LT

Abstract

A major obstacle for orthotopic liver transplantation (OLT) as treatment for hepatocellular carcinoma (HCC) is tumor growth resulting in dropout from the waiting list for OLT. There is a paucity of data on survival according to intention-to-treat analysis and the rate of dropout from the waiting list for OLT among patients with HCC. To further evaluate these issues, we analyzed the outcome of 46 consecutive patients with HCC listed for OLT between January 1998 and January 2001. Exclusion criteria for OLT were tumor size greater than 5 cm for one to three lesions or four lesions or greater of any size. Twenty-one patients underwent OLT. There were 11 dropouts because of tumor progression and six deaths, including three deaths after dropout. Kaplan-Meier 1- and 2-year intention-to-treat survival rates were 91.7% and 72.6%, respectively. Monthly dropout rates were 0% from 0 to 3 months, 1.5% from 3 to 6 months, 1.0% from 6 to 9 months, 4.9% from 9 to 12 months, and 5.6% from 12 to 15 months. One dropout occurred beyond 15 months among 4 patients remaining at risk. Cumulative probabilities for dropout at 6, 12, and 24 months were 7.3%, 25.3%, and 43.6%, respectively. Predictors for dropout included two or three tumor nodules or a solitary lesion greater than 3 cm at initial presentation and previous hepatic resection. Our results support recent changes in the scheme of organ allocation aimed at reducing the dropout rate and improving outcome for patients with HCC awaiting OLT.

Authors+Show Affiliations

Department of Medicine, Division of Gastroenterology, University of California, San Francisco, CA 94143-0538, USA. yaofyk@itsa.ucsf.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

12360427

Citation

Yao, Francis Y., et al. "Liver Transplantation for Hepatocellular Carcinoma: Analysis of Survival According to the Intention-to-treat Principle and Dropout From the Waiting List." Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, vol. 8, no. 10, 2002, pp. 873-83.
Yao FY, Bass NM, Nikolai B, et al. Liver transplantation for hepatocellular carcinoma: analysis of survival according to the intention-to-treat principle and dropout from the waiting list. Liver Transpl. 2002;8(10):873-83.
Yao, F. Y., Bass, N. M., Nikolai, B., Davern, T. J., Kerlan, R., Wu, V., Ascher, N. L., & Roberts, J. P. (2002). Liver transplantation for hepatocellular carcinoma: analysis of survival according to the intention-to-treat principle and dropout from the waiting list. Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, 8(10), 873-83.
Yao FY, et al. Liver Transplantation for Hepatocellular Carcinoma: Analysis of Survival According to the Intention-to-treat Principle and Dropout From the Waiting List. Liver Transpl. 2002;8(10):873-83. PubMed PMID: 12360427.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Liver transplantation for hepatocellular carcinoma: analysis of survival according to the intention-to-treat principle and dropout from the waiting list. AU - Yao,Francis Y, AU - Bass,Nathan M, AU - Nikolai,Bev, AU - Davern,Timothy J, AU - Kerlan,Robert, AU - Wu,Victor, AU - Ascher,Nancy L, AU - Roberts,John P, PY - 2002/10/3/pubmed PY - 2003/2/22/medline PY - 2002/10/3/entrez SP - 873 EP - 83 JF - Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society JO - Liver Transpl VL - 8 IS - 10 N2 - A major obstacle for orthotopic liver transplantation (OLT) as treatment for hepatocellular carcinoma (HCC) is tumor growth resulting in dropout from the waiting list for OLT. There is a paucity of data on survival according to intention-to-treat analysis and the rate of dropout from the waiting list for OLT among patients with HCC. To further evaluate these issues, we analyzed the outcome of 46 consecutive patients with HCC listed for OLT between January 1998 and January 2001. Exclusion criteria for OLT were tumor size greater than 5 cm for one to three lesions or four lesions or greater of any size. Twenty-one patients underwent OLT. There were 11 dropouts because of tumor progression and six deaths, including three deaths after dropout. Kaplan-Meier 1- and 2-year intention-to-treat survival rates were 91.7% and 72.6%, respectively. Monthly dropout rates were 0% from 0 to 3 months, 1.5% from 3 to 6 months, 1.0% from 6 to 9 months, 4.9% from 9 to 12 months, and 5.6% from 12 to 15 months. One dropout occurred beyond 15 months among 4 patients remaining at risk. Cumulative probabilities for dropout at 6, 12, and 24 months were 7.3%, 25.3%, and 43.6%, respectively. Predictors for dropout included two or three tumor nodules or a solitary lesion greater than 3 cm at initial presentation and previous hepatic resection. Our results support recent changes in the scheme of organ allocation aimed at reducing the dropout rate and improving outcome for patients with HCC awaiting OLT. SN - 1527-6465 UR - https://www.unboundmedicine.com/medline/citation/12360427/Liver_transplantation_for_hepatocellular_carcinoma:_analysis_of_survival_according_to_the_intention_to_treat_principle_and_dropout_from_the_waiting_list_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1527646502000515 DB - PRIME DP - Unbound Medicine ER -