Revisiting the role of pathological analysis in transarterial chemoembolization-treated hepatocellular carcinoma after transplantation.
AIM
To define the histopathological features predictive of post-transplant hepatocellular carcinoma (HCC) recurrence after transarterial chemoembolization, applicable for recipient risk stratification.


METHODS
We retrospectively reviewed the specimens of all suspicious nodules (total 275) from 101 consecutive liver transplant recipients which came to our Pathology Unit over a 6-year period. All nodules were sampled and analyzed, and follow-up data were collected. We finally considered 11 histological variables for each patient: total number of nodules, number of viable nodules, size of the major nodule, size of the major viable nodule, occurrence of microscopic vascular invasion, maximum Edmondson's grade, clear cell/sarcomatous changes, and the residual neoplastic volume. Survival data were computed by means of the Kaplan-Meier procedure and analyzed by means of the Cox proportional hazards model. The multivariate linear regression and a k-means cluster analysis were also used in order to compute the standardized histological score.


RESULTS
The total number of nodules, the residual neoplastic volume (the total volume of all evaluated nodules minus the necrotic portion) and the microvascular invasion entered the Cox multivariate hazard model with HCC recurrence as dependent variable. The histological score was therefore computed and a cluster analysis sorted recipients into 3 risk groups, with 3.3%, 18.5% and 53.8% respectively of tumor recurrence rates and 1.6%, 11.1% and 38.5% of tumor-related mortality respectively at the end of follow-up.


CONCLUSION
The histological score allows a reliable stratification of HCC recurrence risk, especially in those recipients found out to be beyond the Milan criteria after orthotopic liver transplantation (OLT).
['Vasuri|Francesco|F|', 'Malvi|Deborah|D|', 'Rosini|Francesca|F|', 'Baldin|Pamela|P|', 'Fiorentino|Michelangelo|M|', 'Paccapelo|Alexandro|A|', 'Ercolani|Giorgio|G|', 'Pinna|Antonio Daniele|AD|', 'Golfieri|Rita|R|', 'Morselli-Labate|Antonio Maria|AM|', 'Grigioni|Walter Franco|WF|', "D'Errico-Grigioni|Antonia|A|"]
D000328:Adult D000368:Aged D006528:Carcinoma, Hepatocellular D016461:Chemoembolization, Therapeutic D017024:Chemotherapy, Adjuvant D005260:Female D006801:Humans D007558:Italy D053208:Kaplan-Meier Estimate D016014:Linear Models D008113:Liver Neoplasms D016031:Liver Transplantation D008297:Male D008875:Middle Aged D015999:Multivariate Analysis D020360:Neoadjuvant Therapy D009364:Neoplasm Recurrence, Local D009367:Neoplasm Staging D016016:Proportional Hazards Models D012189:Retrospective Studies D018570:Risk Assessment D012307:Risk Factors D013997:Time Factors D016896:Treatment Outcome
Hepatocellular carcinoma Histopathology Transarterial chemoembolization Chemoembolization Orthotopic liver transplantation Cancer recurrence