Liver resection versus transplantation for multiple hepatocellular carcinoma: a propensity score analysis.

Chuan Li,Wei Peng,Jia-Yin Yang,Wen-Tao Wang,Jia-Ye Liu,Lu-Nan Yan,Tian-Fu Wen,Ming-Qing Xu,Bo Li

doi:10.18632/oncotarget.20623

Abstract

The aim of this study was to compare the outcomes of patients with multiple hepatocellular carcinoma (HCCs) after liver resection (LR) versus liver transplantation (LT). Patients who had multiple HCCs without macrovascular invasion and who underwent LT or LR between 2007 and 2013 were reviewed. A propensity score matching model was used to adjust baseline differences between the two groups. A total of 204 patients were selected for the current study, including 137 LR patients and 67 LT patients. During follow-up, 100 patients experienced recurrence, and 78 patients died. The 5-year recurrence-free survival rate was 71.1% for the LT group and 31.1% for the LR group (P<0.001). The 5-year overall survival rate was 73.4% for the LT group and 39.8% for the LR group (P<0.001). Moreover, the LT group had better recurrence-free survival and overall survival rates than the LR group regardless of whether the patients met or exceeded the Milan criteria. The multivariate analysis showed that microvascular invasion and LR were independent risk factors for postoperative recurrence, whereas only LR was associated with an increased incidence of mortality. After applying one-to-one propensity score matching, similar results were observed in the propensity score matching model. Our study suggested that LT provided a better prognosis for patients with multiple HCCs than LR regardless of whether the patients met the Milan criteria.

Highlights

Hepatocellular carcinoma (HCC) is the sixth most common malignancy and the third leading cause of cancer-related death worldwide.[1]
The aim of this study is to clarify whether liver transplantation (LT) or liver resection (LR) is a better curative management practice for patients with multiple HCCs based on their recurrence-free and overall survival
Many studies have confirmed that multiple tumors are associated with an increased incidence of postoperative recurrence and a decreased survival rate.[6, 7]

Summary

Introduction

Hepatocellular carcinoma (HCC) is the sixth most common malignancy and the third leading cause of cancer-related death worldwide.[1]. According to the Barcelona Clinic Liver Cancer (BCLC) staging system, both liver transplantation and resection are recommended for patients with multiple HCCs within the Milan criteria (i.e., a single tumor up to 5 cm, up to 3 tumors with each tumor no larger than 3 cm, and a lack of vascular invasion or extrahepatic metastasis).[8, 9] transcatheter arterial chemoembolization (TACE) is the standard treatment for patients with multiple HCCs outside of the Milan criteria, a number of studies have confirmed that these patients may benefit from liver resection.[9,10,11] A randomized comparative trial performed by Lin et al[12] confirmed that overall survival following liver resection was superior to overall survival following TACE for patients with multiple HCCs outside of the Milan criteria. Some transplant selection criteria allow some patients with multiple HCCs beyond the Milan criteria (e.g., the up-to-seven criteria and the Hangzhou criteria) to undergo LT.[13, 14] whether LT or LR offer better outcomes for patients with multiple HCCs is unclear

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Methods

Conclusion