Selection of surgical procedure in the treatment of early hepatocellular carcinoma

Abstract

Objective To discuss the selection of surgical procedure for early hepatocellular carcinoma (HCC) patients by comparing the efficacy of liver resection and transplantation and analyzing the independent risk factors of patients' survival. Methods Clinical data of 53 HCC patients received hepatic resection or liver transplantation in the First Affiliated Hospital, School of Medicine, Xi'an Jiaotong University from January 2002 to December 2009 were analyzed retrospectively. The patients were pathologically confirmed as HCC and met with the Milan criteria. The patients were divided into the liver resection group and liver transplantation group. There were 31 cases in the liver resection group (22 males and 9 females) with the age of (54±10) years old. There were 22 cases in the transplantation group (19 males and 3 females) with the age of (49±9) years old. The informed consents of all patients were obtained and the ethical committee approval was received. The general clinical data of the patients were compared by t test, rank sum test, and chi-square test. And the prognosis analysis of patients in the 2 groups were conducted using Cox multiple regression model. Results There were no significant differences in the patients' age, gender, positive rate of hepatitis B surface antigen (HBsAg) and hepatitis C virus antibody, alpha-fetoprotein (AFP), Child-Pugh grading, tumor numbers, size, liver capsule infiltration and tumor Edmonson grading between 2 groups (all in P>0.05). All the patients were followed up for 6-91 months with an average of 35 months. The 1-, 2-, 3-year cumulative survival rates were 87%, 80%, 71% in the liver resection group and were 86%, 77%, 68% in the liver transplantation group respectively. There was no significant difference in the cumulative survival rate beween 2 groups (χ2=0.739, P>0.05). The 1-, 2-, 3-year disease free survival rates were 84%, 77%, 74% in the liver resection group and were 77%, 68%, 59% in the liver transplantation group. There was no significant difference in the disease free survival rate between 2 groups (χ2=0.826, P>0.05). For the Child-Pugh grade A patients, no significant differences were observed in the comparison of cumulative survival rates and disease free survival rates between 2 groups (χ2=2.562, 2.676; P>0.05) , which was the same as the grade B patients (χ2=0.006, 0.012; P>0.05) . The surgical procedure and tumor Edmonson grading were significantly related with the patients' prognosis (RR=0.291, 5.878; P=0.025, 0.020) . The patients who received liver resection and with high degree of tumor differentiation had better prognosis. Conclusions For the HCC patients within Milan Criteria and with liver function of Child-Pugh grade A or B, liver resection should be the preferred treatment. The patients' prognosis after the operation is related with tumor differentiation. The patients with high degree of tumor differentiation have better prognosis. Key words: Carcinoma, hepatocellular; Liver transplantation; Hepatectomy