Liver Transplantation – The Best and Last Chance of Cure for Hepatocellular Carcinoma with Portal Vein Invasion

Abstract

Introduction: Hepatocellular carcinoma (HCC) with portal vein invasion is a sign of advance disease. Liver transplantation (LT) is generally not considered due to the perceived poor survival. Liver resection is the mainstay of curative treatment for this situation and yet the outcome is exceedingly poor. There has been no study compares the treatment outcomes of these two treatment modalities in this patient subgroup. Method: Consecutive patients were recruited from 2000 to 2016. Patients who received either LT or resection with pathological diagnosis of HCC and portal vein invasion were recruited. Propensity score matching was performed before comparison. Result: There were 88 eligible patients, 13 received LT and 75 received resection respectively. The median age was 55.5 years old and male was the predominant gender. Majority (61.5%) of the patients in the LT group has Vp2 (tumour invasion at the 2nd order portal vein branch) while all patients in the resection group had Vp2 disease. Significant heterogeneity was found between LT and resection group. After propensity score matching, 10 patients in the LT group were compared with 30 patients in the resection group. The median size of tumour, alpha fetoprotein level (AFP) and follow-up period of the matched population was 5cm, 1021 ng/ml and 19 months respectively. Patients in the LT group had significantly better disease-free (median 45.9 vs 5.7 months) and overall survival (median survival 58.2 vs 12.3 months, P=0.026) respectively. Conclusion: LT provides a better chance of cure in HCC patients with portal vein invasion.