Single HCC in Cirrhotic Patients: Liver Resection or Liver Transplantation? Long-term Outcome According to an Intention-to-treat Basis

Abstract

Compensated cirrhotic patients with single hepatocellular carcinoma (HCC) ≤5cm may benefit from both liver resection (LR) and liver transplantation (LT); however, the better 10-year actuarial survival of the two treatments remains unclear. We aimed to assess the long-term outcome of cirrhotic patients with single HCC ≤5cm treated either with LR or LT on an intention-to-treat basis. A total of 217 cirrhotic patients with single HCC ≤5cm were evaluated at our department: 95 were treated with LR (LR group), and 122 were included on the waiting list for LT (LT group). Patients in the LR group were divided into very early HCC (tumor size ≤2cm) and early HCC (tumor size >2cm). Median follow-up was 5.3 (range 0.1-18) years. Tumor recurrence was 72% in the LR group versus 16% in the LT group (p<0.001). 1-, 5-, and 10-year cumulative risk of recurrence was 18, 69, and 83% in the LR group versus 4, 18, and 20% in the LT group (p<0.001). Ten-year actuarial survival was 33% in the LR group versus 49% in the LT group (p=0.002). At HCC recurrence, 27.3% were included on the waiting list for salvage transplantation (very early HCC group) versus 15.1% (early HCC group) (p=0.2). After salvage transplantation, HCC recurrence was 0% (very early HCC group) versus 40% (early HCC group) (p=0.2). No significant differences were observed in 1-, 5-, and 10-year actuarial survival between the very early HCC group and the LT group (95, 55, and 50% vs. 82, 62, and 50%). LR should be the treatment of choice for cirrhotic patients with very early HCC.