Patients with non–[ 18 F]fludeoxyglucose‐avid advanced hepatocellular carcinoma on clinical staging may achieve long‐term recurrence‐free survival after liver transplantation

There is increasing evidence that a relevant number of patients with hepatocellular carcinoma (HCC) exceeding the Milan criteria may benefit from liver transplantation (LT). We retrospectively analyzed the prognostic significance of [ 18 F]fludeoxyglucose ([ 18 F]FDG) positron emission tomography (PET) for identifying appropriate LT candidates with advanced HCC on clinical staging. Between 1995 and 2008, 111 patients with HCC were listed for LT. All underwent a pretransplant PET evaluation. LT was performed for 91 of these patients. The tumor recurrence rate after LT was 3.6% for patients with non–[ 18 F]FDG‐avid (PET − ) tumors, but it was 54.3% for patients with [ 18 F]FDG‐avid (PET + ) tumors ( P < 0.001). The 5‐year recurrence‐free survival rates were comparable for patients with tumors meeting the Milan criteria (86.2%) and patients with PET − HCC exceeding the Milan criteria (81%) at LT, but these rates were significantly higher than the rate for liver recipients with [ 18 F]FDG‐avid advanced HCC (21%, P = 0.002). In a multivariate analysis, negative PET findings (odds ratio = 21.6, P < 0.001), an alpha‐fetoprotein level <400 IU/mL (odds ratio = 3.3, P = 0.013), and a total tumor diameter <10 cm (odds ratio = 3.0, P = 0.022) were identified as pretransplant prognostic variables for recurrence‐free survival. A PET + status was assessed as the only independent clinical predictor of tumor‐related patient dropout from the waiting list (hazard ratio = 5.7, P = 0.01). Patients with non–[ 18 F]FDG‐avid HCC beyond the Milan criteria according to clinical staging may achieve excellent long‐term recurrence‐free survival after LT. Liver Transpl 18:53–61, 2012. © 2011 AASLD.