Survival outcomes of liver transplantation versus liver resection among patients with hepatocellular carcinoma: A SEER-based longitudinal study

Abstract

This study aimed to compare the survival benefit in hepatocellular carcinoma (HCC) patients following liver transplantation or surgical resection utilizing Surveillance, Epidemiology, and End Results Program (SEER) database (2004-2013). Overall and cancer-specific mortality were evaluated in HCC patients who were treated by liver resection or transplantation. Patients newly-diagnosed with primary HCC were included. Kaplan-Meier survival curves found that patients with liver transplantation had lower risk of overall mortality and cancer-free mortality than patients who received liver resection (P<0.001). Multivariate analysis found the risk of overall and cancer-specific mortality were lower with liver transplantation than with resection (aHR=0.51 for overall mortality and aHR=0.37 for cancer specific mortality), and that the risk of overall mortality decreased for patients with liver transplantation relative to surgical resection as disease severity increased (T1: aHR=0.53; T2: aHR=0.47; T3 and T4: aHR=0.33). The findings indicated that transplantation has survival advantages compared with resection in treating patients with HCC, particularly in later stage disease.