Liver transplantation for hepatocellular carcinoma: A proposal of a prognostic scoring system

Shunzaburo Iwatsuki, Igor Dvorchik, J. Wallis Marsh, Juan R. Madariaga, Brian Carr, John J. Fung, Thomas E. Starzl

Research output: Contribution to journalArticlepeer-review


Background: The current staging system of hepatocellular carcinoma established by the International Union Against Cancer and the American Joint Committee on Cancer does not necessarily predict the outcomes after hepatic resection or transplantation. Study Design: Various clinical and pathologic risk factors for tumor recurrence were examined on 344 consecutive patients who received hepatic transplantation in the presence of nonfibrolamellar hepatocellular carcinoma to establish a reliable risk scoring system. Results: Multivariate analysis identified three factors as independently significant poor prognosticators: 1) bilobarly distributed tumors, 2) size of the greatest tumor (2 to 5 cm and > 5 cm), and 3) vascular invasion (microscopic and macroscopic). Prognostic risk score (PRS) of each patient was calculated from the relative risks of multivariate analysis. The patients were grouped into five grades of tumor recurrence risk: grade 1: PRS = 0 to <7.5; grade 2: PRS = 7.5 to ≤ 11.0; grade 3: PRS > 11.0 to 15.0; grade 4: PRS ≥ 15.0; and grade 5: positive node, metastasis, or margin. The proposed PRS system correlated extremely well with tumor-free survival after liver transplantation (100%, 61%, 40%, 5%, and 0%, from grades 1 to 5, respectively, at 5 years), but current pTNM staging did not. Conclusions: 1) Patients with grades 1 and 2 are effectively treated with liver transplantation, 2) patients with grades 4 and 5 are poor candidates for liver transplantation, and 3) patients with grade 1 do not benefit from adjuvant chemotherapy. (C) 2000 by the American College of Surgeons.

Original languageEnglish
Pages (from-to)389-394
Number of pages6
JournalJournal of the American College of Surgeons
Issue number4
Publication statusPublished - 2000

ASJC Scopus subject areas

  • Surgery


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