Adjuvant chemotherapy improves survival after liver transplantation for hepatocellular carcinoma

Kim M. Olthoff, Michael H. Rosove, Christopher R. Shackleton, David K. Imagawa, Douglas G. Farmer, Petronella Northcross, Anita L. Pakrasi, Paul Martin, Leonard I. Goldstein, Abraham Shaked, Ronald W. Busuttil

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Abstract

Objective: The aim of this study was to evaluate the effect of postoperative adjuvant chemotherapy on the recurrence rate and survival of patients after orthotopic liver transplantation (OLT) for hepatocellular carcinoma (HCC). Summary Background Data: Historically, liver transplantation for HCC has yielded poor long term survival. Multimodality therapy has been initiated in an effort to improve survival statistics. Methods: Twenty-five patients were placed on 6 months of intravenous fluorouracil, doxorubicin, and cisplatin after OLT. Risk factors, recurrence rates, and survival rates were analyzed and compared with historic controls. Results: Overall long- term survival in the protocol patients was 46% at 3 years, improved over our historic controls of 5.8% at 3 years (p = 0.0001). Overall recurrence rate was 20% (n = 4). Possible risk factors, such as tumor size, vascular invasion, multilocality, capsular invasion, and tumor differentiation, were not found to be significantly predictive of survival. Three patients with long term, disease free survival had tumors > 5 cm. Side effects from chemotherapy were common, but rarely severe. Conclusions: This study suggests that adjuvant chemotherapy after transplantation for HCC can provide long term cure and may improve survival, even in patients with stage III and IV disease.

Original languageEnglish
Pages (from-to)734-743
Number of pages10
JournalAnnals of Surgery
Volume221
Issue number6
StatePublished - Jun 1 1995
Externally publishedYes

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Adjuvant Chemotherapy
Liver Transplantation
Hepatocellular Carcinoma
Survival
Recurrence
Survival Rate
Neoplasms
Fluorouracil
Doxorubicin
Cisplatin
Disease-Free Survival
Blood Vessels
Transplantation
Drug Therapy
Therapeutics

ASJC Scopus subject areas

  • Surgery

Cite this

Olthoff, K. M., Rosove, M. H., Shackleton, C. R., Imagawa, D. K., Farmer, D. G., Northcross, P., ... Busuttil, R. W. (1995). Adjuvant chemotherapy improves survival after liver transplantation for hepatocellular carcinoma. Annals of Surgery, 221(6), 734-743.

Adjuvant chemotherapy improves survival after liver transplantation for hepatocellular carcinoma. / Olthoff, Kim M.; Rosove, Michael H.; Shackleton, Christopher R.; Imagawa, David K.; Farmer, Douglas G.; Northcross, Petronella; Pakrasi, Anita L.; Martin, Paul; Goldstein, Leonard I.; Shaked, Abraham; Busuttil, Ronald W.

In: Annals of Surgery, Vol. 221, No. 6, 01.06.1995, p. 734-743.

Research output: Contribution to journalArticle

Olthoff, KM, Rosove, MH, Shackleton, CR, Imagawa, DK, Farmer, DG, Northcross, P, Pakrasi, AL, Martin, P, Goldstein, LI, Shaked, A & Busuttil, RW 1995, 'Adjuvant chemotherapy improves survival after liver transplantation for hepatocellular carcinoma', Annals of Surgery, vol. 221, no. 6, pp. 734-743.
Olthoff KM, Rosove MH, Shackleton CR, Imagawa DK, Farmer DG, Northcross P et al. Adjuvant chemotherapy improves survival after liver transplantation for hepatocellular carcinoma. Annals of Surgery. 1995 Jun 1;221(6):734-743.
Olthoff, Kim M. ; Rosove, Michael H. ; Shackleton, Christopher R. ; Imagawa, David K. ; Farmer, Douglas G. ; Northcross, Petronella ; Pakrasi, Anita L. ; Martin, Paul ; Goldstein, Leonard I. ; Shaked, Abraham ; Busuttil, Ronald W. / Adjuvant chemotherapy improves survival after liver transplantation for hepatocellular carcinoma. In: Annals of Surgery. 1995 ; Vol. 221, No. 6. pp. 734-743.
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AU - Rosove, Michael H.

AU - Shackleton, Christopher R.

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AU - Farmer, Douglas G.

AU - Northcross, Petronella

AU - Pakrasi, Anita L.

AU - Martin, Paul

AU - Goldstein, Leonard I.

AU - Shaked, Abraham

AU - Busuttil, Ronald W.

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N2 - Objective: The aim of this study was to evaluate the effect of postoperative adjuvant chemotherapy on the recurrence rate and survival of patients after orthotopic liver transplantation (OLT) for hepatocellular carcinoma (HCC). Summary Background Data: Historically, liver transplantation for HCC has yielded poor long term survival. Multimodality therapy has been initiated in an effort to improve survival statistics. Methods: Twenty-five patients were placed on 6 months of intravenous fluorouracil, doxorubicin, and cisplatin after OLT. Risk factors, recurrence rates, and survival rates were analyzed and compared with historic controls. Results: Overall long- term survival in the protocol patients was 46% at 3 years, improved over our historic controls of 5.8% at 3 years (p = 0.0001). Overall recurrence rate was 20% (n = 4). Possible risk factors, such as tumor size, vascular invasion, multilocality, capsular invasion, and tumor differentiation, were not found to be significantly predictive of survival. Three patients with long term, disease free survival had tumors > 5 cm. Side effects from chemotherapy were common, but rarely severe. Conclusions: This study suggests that adjuvant chemotherapy after transplantation for HCC can provide long term cure and may improve survival, even in patients with stage III and IV disease.

AB - Objective: The aim of this study was to evaluate the effect of postoperative adjuvant chemotherapy on the recurrence rate and survival of patients after orthotopic liver transplantation (OLT) for hepatocellular carcinoma (HCC). Summary Background Data: Historically, liver transplantation for HCC has yielded poor long term survival. Multimodality therapy has been initiated in an effort to improve survival statistics. Methods: Twenty-five patients were placed on 6 months of intravenous fluorouracil, doxorubicin, and cisplatin after OLT. Risk factors, recurrence rates, and survival rates were analyzed and compared with historic controls. Results: Overall long- term survival in the protocol patients was 46% at 3 years, improved over our historic controls of 5.8% at 3 years (p = 0.0001). Overall recurrence rate was 20% (n = 4). Possible risk factors, such as tumor size, vascular invasion, multilocality, capsular invasion, and tumor differentiation, were not found to be significantly predictive of survival. Three patients with long term, disease free survival had tumors > 5 cm. Side effects from chemotherapy were common, but rarely severe. Conclusions: This study suggests that adjuvant chemotherapy after transplantation for HCC can provide long term cure and may improve survival, even in patients with stage III and IV disease.

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