SAN FRANCISCOLiver transplantation is lifesaving in patients with localized hepatocellular carcinoma, with some 75% of transplant recipients still alive 5 years later, compared with only 12% of other patients, finds the first large population-based study of this treatment for this disease. However, African-American, Hispanic, and Asian patients are only about half as likely to undergo transplant as their white counterparts.Liver cancer has not received much attention in the United States until recently, said lead author Abby Siegel, MD, assistant professor of medicine, Columbia University. "We think, primarily because of the hepatitis C epidemic, the incidence has actually doubled in the United States over the last 30 years," she said at the 2006 Gastrointestinal Cancers Symposium (abstract 163).
Kaplan-Meier survival curves for transplant vs other treatment for hepatocellular carcinoma.
She noted that in mainly single-institution studies conducted among highly selected patients with hepatocellular carcinoma, namely, those meeting the Milan criteria (one tumor measuring 5 cm or less in diameter or three tumors each measuring less than 3 cm), the 5-year survival with transplantation is fairly high, about 75%, but it is unknown if this outcome bears out in broader populations.
To determine if the Milan criteria hold true among the general US population with hepatocellular cancer and also to assess predictors of liver transplantation among potentially eligible patients, Dr. Siegel and her colleagues analyzed Surveillance, Epidemiology, and End Results (SEER) data. "At the time that we did the study, SEER accounted for about 14% of the US population," she noted.
Analyses were based on 1,156 adults in the database who had nonmetastatic hepatocellular carcinoma measuring 5 cm or less in diameter that was diagnosed during the years 1998-2002. The SEER data align generally well though not perfectly with Milan criteria, providing only extent of disease (localized, regional, or distant) and tumor size, Dr. Siegel noted.
Patients were classified as to whether they received liver transplant; the nontransplanted group included patients who underwent resection or ablation, had chemotherapy or other therapies, or received only palliative care.
The patients' median age was 61 years, and nearly three-fourths were men, Dr. Siegel said. Some 45% were white, 29% were Asian, 17% Hispanic, and 9% African American. All of the patients had localized disease; 48% had low-grade tumors, and 81% did not have any vascular invasion.