L. Woolf1, R. S. Mangus1, A. J. Tector1, K. Ridlen1, M. Maluccio1 1Indiana University School Of Medicine,Surgery/Tranplant,Indianapolis, IN, USA
Introduction:
The absolute impact of given a given treatment for cancer is measured by how long a patient lives compared to their expected survival. For patients with hepatocellular carcinoma (HCC), life expectancy is often determined by the combination of liver related and tumor related variables. The Cancer of the Liver Italian Program Investigators (CLIP) score is one validated measure of survival in patients with HCC and has been used to assess disease free and overall survival in a large cohort of patients. The objective of this study was to evaluate the impact of transplantation on survival of HCC patients by comparing preoperative CLIP score estimates of life expectancy to post transplant survival.
Methods:
Records from a database of 1572 consecutive adult liver transplants performed at Indiana University between July 2001 and June 2015 were reviewed. Of these patients, 376 had HCC. CLIP scores were calculated for all patients, and patients were stratified by scores 0-1 (low risk), 2 (intermediate risk), and 3-4 (high risk). Life expectancy was estimated based on published survival rates for each CLIP score category. Post transplant survival was calculated using Kaplan-Meier methodology. The absolute survival benefit for each group was evaluated by comparing the average survival of all patients in each group compared to the estimated survival by CLIP score analysis.
Results:
The mean death-censored follow up for the entire population was 61 months from the date of transplant. The median survival has not yet been met. The mean actuarial survival was: 112 months, 108 months, and 77 months for CLIP 0-1, 2, and 3-4 respectively. This was compared to pre-transplant life expectancies of 38 months, 17 months, and 4 months, respectively. Therefore, for the three study groups, survival is increased by a minimum of 74, 91, and 73 months, respectively. 10 year survival is shown in the figure.
Conclusion:
Liver transplantation prolongs survival in the vast majority of patients with hepatocellular carcinoma compared to pre-transplant survival estimates. For the individual cancer patient with HCC, transplantation is the most promising treatment currently available.
