Liver transplantation versus surgical resection for HCC meeting the Milan criteria

Abstract

The optimal treatment (liver transplantation [LT] vs surgical resection [SR]) for early-stage hepatocellular carcinoma (HCC) remains controversial.A total of 209 SR patients and 129 LT patients were identified at our institution. After eliminating 27 patients with Child–Pugh C, the data from 209 SR patients and 102 LT patients were analyzed using a propensity score matching (PSM) model. Forty-six pairs were generated. A subgroup analysis was conducted based on the alpha-fetoprotein (AFP) level or platelet count (PLT). A survival analysis was performed using the Kaplan–Meier method.Gender, satellite lesions, and the treatment method were predictors of HCC recurrence. The Ishak score and treatment methods were associated with long-term survival after surgery. Before PSM, LT patients had a better prognosis than those treated by SR. Among HCC patients with childhood A/B cirrhosis, after PSM, SR achieved similar overall survival outcomes compared with LT. LT and SR resulted in comparable long-term survival for patients with or without thrombocytopenia. Patients with an AFP ≥ 400 ng/mL might achieve more survival benefits from LT.Our propensity score model provided evidence that, compared with transplantation, surgical resection could result in comparable long-term survival for resectable early-stage HCC patients, except for the AFP ≥ 400 ng/mL HCC subgroup. Surgical resection might not be a contraindication for early-stage HCC patients with thrombocytopenia due to their similar prognosis after transplantation.

A High Preoperative Platelet-Lymphocyte Ratio Is a Negative Predictor of Survival After Liver Resection for Hepatitis B Virus-Related Hepatocellular Carcinoma: A Retrospective Study

“…The reasons why the patients who met the Milan criteria did not receive LT in this study were: (1) refusal to LT; (2) failure of affording the high cost of LT; (3) organ shortage; (4) concern about severe adverse effects of long term oral immunosuppressive agents after LT. In addition, previous studies indicated that overall survival of patients with Milan criteria after liver resection (LR) were comparable to those after LT (12)(13)(14). This observation may be attributable to advances in liver surgery, perioperative therapies for patients with liver cirrhosis, and the development of advanced multimodality for the recurrent lesions.…”

Meta‐analysis of laparoscopic versus open liver resection for hepatocellular carcinoma

“…However, the prognosis of patients with HCC remains poor, probably due to diagnosis at a late stage. Other treatments include radiofrequency ablation (RFA), microwave ablation, high intensity focused ultrasound ablation, transarterial chemoembolization (TACE), and liver transplantation …”

“…Other treatments include radiofrequency ablation (RFA), microwave ablation, high intensity focused ultrasound ablation, transarterial chemoembolization (TACE), and liver transplantation. 6,7 Since the first laparoscopic liver hepatectomy (LH) in 1992, 8 and the report of the first LH for HCC was published in 1995, 9 laparoscopic hepatectomy is being increasingly used for HCC. Laparoscopic hepatectomy was initially considered controversial, but there has been constant improvement in laparoscopic techniques and devices, and accumulating data, which have led to a more widespread acceptance of LH as a minimally invasive approach for the resection of HCC over the last 15 years.…”

Comparison between liver resection and liver transplantation on outcomes in patients with solitary hepatocellular carcinoma meeting UNOS criteria: a population-based study of the SEER database

“…No prospective randomized studies has been conducted to compare the effectiveness of LR and LT in this type of patients. Though several retrospective studies focused on this issue, their results were controversial due to different eligibility criteria, especially in tumor size, lesion number and vascular invasion [ 9 – 11 , 13 , 14 ]. According to a meta-analysis comparing outcomes of LR and LT in patients with early HCC, LT group had a survival advantage in certain settings.…”