Liver transplantation due to hepatocellular carcinoma: prognostic relevance of quantitative DNA ploidy

H. Al-Abadi, MD, T. Steinmueller, S. Jonas, I. Rotter, P. Neuhaus

Department of Surgery, Charite, Campus Virchow Klinikum, Humboldt University of Berlin, Germany

Aim: The histomorphological classification of HCC is difficult, mainly because there is no valid grading system so far, providing reliable and reproducible results. According to previous study, liver transplantation should only be considered as a treatment option for a selected subset of patients suffering from HCC. In a prospective study we investigated the clinical relevance of Quantitative DNA-Ploidy for patients receiving liver transplantation due to HCC. Patients and Methods: The study reviewed 1136 patients undergoing liver transplantation between January 1989 and December 1999. Thereof 115 patients receiving liver transplantation, presented HCC in the explanted liver. In a prospective study we enrolled 87 patients for which DNA-cytometry data were available. The follow-up period ranged up to 10 years. The DNA-ploidy was determined by means of image cytometry on nuclei isolated from formalin fixed and paraffin embedded archival material. Results: The results of DNA analysis were related to the tumor categories, histopathological grading, and the clinical course. A significant correlation was found between the results of DNA cytometry and the clinical course of the disease. Patients with diploid tumor cell lines had no metastasis and no local tumor progression during the follow up time whereas patients with aneuploid cell line suffered recurrence and tumor progression. The difference of tumor progression between diploid and aneuploid tumors were highly significant (P<0.001). Conclusion: Quantitative DNA-ploidy is a useful, additional diagnostic tool to predict clinical outcome of liver transplanted HCC patients.

KEY WORDS: Keywords HCC, DNA ploidy, liver transplantation.

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Paper presented at the International Symposium on Predictive Oncology and Intervention Strategies; Paris, France; February 9 - 12, 2002; in the section on Prognostic Markers.