Outcome after liver transplantation, resection and ablation for hepatocellular carcinoma in Sweden – A national registry-based study 2008 – 2016

Abstract

Introduction: Patients with limited hepatocellular carcinoma (HCC) and well-preserved liver function can be treated by liver transplantation, resection or ablation. Transplantation offers good long-term results, but with a relatively high post-operative morbidity and long-term complications. Liver resection is associated with a high risk of recurrent cancer. Liver ablation has increased lately, both as a single curative option and while waiting for transplantation, as complication rates are favorable. Our objectives were to compare outcome after liver transplantation, resection or ablation respectively, in relation to tumor stage, liver function and comorbidities. Methods: Prospectively collected data was retrieved from national Swedish Quality Registry (SweLiv) for HCC-patients, treated 2008-2016 in Sweden. Overall survival and cumulative incidence of tumor recurrences were analyzed for each treatment group. Preliminary results: During 2008 - 2016, 3590 patients were diagnosed with HCC; 31% by surveillance, while 11% were incidental radiologic findings. Curatively aiming treatments were given in 1253 patients (35%); transplantation in 273, resection in 544 and ablation in 436 patients. Median time from diagnosis to treatment was 223, 83 and 107 days respectively. Five year overall survival was 52% for patients who had resection, 76% for transplantation and 35% for ablation. After 2 years, the probabilities for recurrence and for death without recurrence were 9% and 5% respectively after transplantation, 36% and 12% after resection and 44 and 14 % respectively after ablation. Conclusion: Recurrences and deaths without recurrence were more common after resection/ablation than after liver transplantation. Adjusted subgroup analyses will be done.