Long-term Outcomes of Liver Transplantation versus Resection for Hepatocellular Carcinoma: A Single-Center Experience

Abstract

Introduction: Hepatocellular carcinoma (HCC) is the fourth leading cause of cancer deaths worldwide. Liver transplantation (LT) and liver resection (LR) are mainstay treatments for HCC. We compared the clinicopathologic features and long-term prognosis between patients receiving LT and LR for HCC. Methods: All patients who underwent LT or LR from 2010-2020 for HCC at a US transplant center were included. A total of 321 patients (137 LR, 184 LT) were enrolled. Overall survival (OS) and disease-free survival (DFS) were compared between LT and LR according to Milan criteria. Univariate and multivariable analyses including clinicopathologic factors were performed for both groups. Results: Significant differences in clinicopathologic factors existed between LT and LR groups; LT patients were more likely to be male, Caucasian, have higher MELD, cirrhosis, and be within Milan criteria. The OS rates at 1/5/7 years for LT and LR groups were 94.0%/77.5%/71.1% vs 79.3%/48.3%/38.5%, respectively (p <0.001). The DFS rates at 1/5/7 years for LT and LR groups were 98.2%/84.6%/84.6% vs. 71.9%/42.5%/24.8%, respectively (p <0.001). For patients beyond Milan criteria, LT group showed significantly better OS rate compared to LR group (p=0.002). Regarding DFS rates, LT groups showed significantly better survival compared to LR both within and beyond Milan criteria (p <0.001). In multivariable analysis, Milan criteria was the only significant prognostic factor for DFS in both groups (HR 31.29 LT, p=0.039; HR 4.516 LR, p=0.020). Conclusions: Liver transplantation is associated with better long-term clinical outcomes than liver resection for the treatment of HCC.