Occult multifocal and incidental hepatocellular carcinoma: An analysis of long-term survival and risk factors at a single liver transplant center

作者：Dominic Amara, Wethit Dumronggittigule, Andrew Melehy, Daniela Markovic, Lynn Nguyen, Shannon Nesbit, David Lu, Samer Ebaid, Fady M. Kaldas, Douglas G. Farmer, Ronald W. Busuttil, Vatche G. Agopian · 发表于：Liver Transplantation · 年份：2025 · DOI：10.1097/lvt.0000000000000640 · 被引用次数：2 · 研究领域：Transplantation: Methods and Outcomes、Viral-associated cancers and disorders、Renal Transplantation Outcomes and Treatments

The clinical significance of occult HCC identified on explant pathology in liver transplantation (LT) remains unclear. Among recipients of LT, discordance between pre-LT radiographic assessment of HCC and explant tumor burden is common. Data regarding the association of incidental HCC (no pre-LT radiographic diagnosis) and occult multifocal hepatocellular carcinoma (omHCC, pre-LT radiology underestimates a number of explant tumors) with outcomes are scarce. Post-LT recurrence and survival were compared among recipients of LT (n=919, 2002-2019) with incidental HCC (n=129), omHCC (n=349), and non-omHCC (n=437). Multivariable analysis identified independent predictors of omHCC in the subset of patients with kHCC. Compared to kHCC, incidental HCC had similar 5-year overall (OS) and recurrence-free survival (RFS), lower post-LT recurrence (6.9% vs. 16.2%, p =0.0019), but higher non-HCC-related mortality (38.4% vs. 23.7%, p =0.0042). Of 790 kHCC, 349 (44.1%) had omHCC, who demonstrated greater radiographic number of lesions ( p =0.049) and locoregional treatments ( p <0.001) but similar maximum and pre-LT alphafetoprotein compared to non-omHCC. Compared to kHCC without omHCC, patients with omHCC had inferior 5-year OS (60.4% vs. 70.9%, p =0.010) and RFS (56.8% vs. 69.7%, p <0.001), higher recurrence (23.8% vs. 9.2%, p <0.001), and similar non-HCC-related mortality. These observations remained true within patients who remained within Milan throughout preoperative imaging (5-y OS: 62...