Copyright ©The Author(s) 2016.
World J Hepatol. Nov 8, 2016; 8(31): 1309-1317
Published online Nov 8, 2016. doi: 10.4254/wjh.v8.i31.1309
Table 1 Comparison between prophylactic liver transplant and wait-and-see before hepatocellular carcinoma recurrence
The strategyProphylactic LTWait-and-see
Immunosuppressant exposureLife-longNil
Surgical morbidity and mortalityPresentNil
Long-term HCC recurrenceLower[32]Higher[11]
Survival benefit (5-year survival rate)84.6%[32]Around 70%[7-10]
Further management after recurrenceHepatectomy, RFA, TACE, Sorafenib, Yttrium-90SLT, repeat hepatectomy, RFA, TACE, Sorafenib, Yttrium-90
Table 2 Prognostic factors of early hepatocellular carcinoma recurrence after liver resection and after liver transplantation
Risk factor of HCC recurrenceAfter liver resectionAfter liver transplantation
AFP> 400 ng/mL[49]> 1000 ng/mL[34,35]
Tumor gross
Tumor size> 3 cm[30] or > 5 cm[37,41,65]> 6 cm[35]
Tumor number> 3[65]≥ 4[35]
Satellite nodulesYes[30,63,66]Yes[33]
Tumor microscopic
Tumor differentiationIntermediate, or poor differentiation, or undifferentiation[30,49,65]Poor differentiation, or undifferentiation[33]
Microvascular invasionYes[30,37,41,49,64-66]Yes[33,34]
Liver parenchyma
Severity of cirrhosisControversial[67-69]No
Milan criteriaYes[68] (predict recurrence within/beyond MC)Yes[3]
Table 3 Scoring systems for predicting hepatocellular carcinoma recurrence
Ref.Basis of scoring systemPrognostic factorsDiscriminated scores
Pan et al[76]Glasgow prognostic scorePreoperative0, 1, 2
CRP > 10 mg/L (1 point)
Albumin < 3.5 g/L (1 point)
Fuks et al[32]Histological featuresMicroscopic vascular invasion< 3 factors
Presence of satellite nodules≥ 3 factors
Tumor size > 3 cm
Poor differentiated tumor
Roayaie et al[66]Degree of vascular invasionInvasion of a vessel with a muscular wall (1 point)0, 1, 2
Invasion of a vessel ≥ 1 cm from the tumor capsule (1 point)
Lee et al[68]Clinical risk scoreInitial disease beyond Milan criteria0, 1, 2, 3
Microsatellites or multiple tumors
Lymphovascular invasion (1 point for each factor)