Primary Living-donor Liver Transplantation Is Not the Optimal Treatment Choice in Patients With Early Hepatocellular Carcinoma With Poor Tumor Biology

Park, M.-S.; Lee, K.-W.; Kim, H.; Choi, Young Rok; Hong, Geun; Yi, Nam‐Joon; Suh, Kyung Suk

doi:10.1016/j.transproceed.2017.03.016

Cited by 10 publications

(8 citation statements)

References 22 publications

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“…In patients with two or more risk factors, recurrence rates after LT were not better than after resection and reached up to 75% at 3 years. Notably, overall survival after LT was significantly worse compared to resection in these high risk patients (54).…”

Section: Futility Rule #4: (Persistently) Increased Afpmentioning

confidence: 88%

Hepatocellular carcinoma: when is liver transplantation oncologically futile?

Viveiros

Zoller

Finkenstedt

2017

Transl. Gastroenterol. Hepatol.

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Section: Futility Rule #4: (Persistently) Increased Afpmentioning

confidence: 88%

Hepatocellular carcinoma: when is liver transplantation oncologically futile?

Viveiros

Zoller

Finkenstedt

2017

Transl. Gastroenterol. Hepatol.

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“…The lower tumor recurrence rate has been the main argument for advocating LT for HCC within the Milan criteria and Child-Pugh class A patients. [ 7 , 10 ] We think that a 74.2% 5-year OS is quite a good level in the LR group. Although the OS rate obtained in the LDLT group was 84.6%, it was not a statistically significant difference.…”

Section: Discussionmentioning

confidence: 96%

“…This study focused on the long-term results after LR and LDLT in patients with HCC within the Milan criteria, but who had preserved liver function, Child-Pugh class A. Although previous studies have reported low survival and high recurrence rates after LR of HCC within the Milan criteria, [9][10][11] there are also favorable results on the outcomes of LR in patients with preserved liver function and HCC within the Milan criteria. [12][13][14] Major society guidelines recommend LR when the hepatic function is preserved and sufficient remnant liver volume is maintained.…”

Section: Discussionmentioning

confidence: 99%

“…Although there are many publications comparing the results of LR and cadaver donor liver transplantation (DDLT) in studies published so far, [6][7][8] we have found very few studies comparing LR and LDLT in terms of overall survival (OS) and DFS in HCC within the Milan criteria. [9,10] Additionally, we think the selection of only the group within the Milan criteria is insufficient to compare the LR and LT results in HCC. LR cannot be performed for every patient with HCC included in the Milan criteria, due to both the anatomical distribution of the tumors and the degree of liver function deterioration.…”

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confidence: 99%

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Comparison of liver resection and living donor liver transplantation in patients with hepatocellular carcinoma within Milan criteria and well-preserved liver function

Karakas¹

2023

Hepatology Forum

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Background and Aim Liver resection (LR) and liver transplantation (LT) are curative treatments for hepatocellular carcinoma (HCC). The main purpose of this study was to compare the survival of LR and LDLT in patients with HCC within the Milan criteria. Materials and Methods The results of the LR (n=67) and LDLT (n=391) groups were compared for overall survival (OS) and disease-free survival (DFS). Twenty-six of the HCCs in the LRs met the Milan and Child A criteria. Also, 200 of the HCC patients in the LDLTs met the Milan criteria, of which 70 also met the Child A criteria. Results Early mortality was higher in the LDLT group (13.9% vs 1.47%; p=0.003). The 5-year OS was higher in the LDLTs than the LRs, but not statistically significant (84.6% vs 74.2%; p=0.287). However, 5-year DFS was better in the LDLT group (96.8% vs 64.3%; p<0.001). When the LRs (n=26) and the LDLTs (n=70) that met both Milan and Child A criteria were compared, 5-year OS was similar (81.4% vs 74.2%; p=0.512), but DFS was better in the LDLTs (98.6% vs 64.3%; p<0.001). Conclusion LR can be justified as the first-line treatment for HCC patients who meet Milan and Child A criteria in terms of early mortality and OS.

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“…The majority of articles were retrospective studies (n=34), except for 1 prospective study; 11 articles provided survival data for uninodular HCC (26,(30)(31)(32)34,43,45,46,53,56,60); 2 0 a r t i c l e s h a d a s t u d y e n d -d a t e b e f o r e 2 0 1 0 (33,(35)(36)(37)40,42,43,45,47,(49)(50)(51)(52)(53)(54)(55)(56)(60)(61)(62). Additionally, 14 studies used enhanced surveillance strategies for HCC surveillance after surgery (26,28,30,(33)(34)(35)40,43,44,(56)(57)(58)61,62). All included studies were of high quality by NOS, with 10 studies having an NOS score of 9, and 25 studies having an NOS score of 8.…”

Section: Study Selection and Study Characteristicsmentioning

confidence: 99%

Liver resection versus liver transplantation for hepatocellular carcinoma within Milan criteria: a meta-analysis of 18,421 patients

Koh¹,

Tan²,

Ong³

et al. 2022

Hepatobiliary Surg Nutr

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Background: Outcomes after liver resection (LR) and liver transplantation (LT) for hepatocellular carcinoma (HCC) are heterogenous and may vary by region, over time periods and disease burden. We aimed to compare overall survival (OS) and disease-free survival (DFS) between LT versus LR for HCC within the Milan criteria.Methods: Two authors independently searched Medline and Embase databases for studies comparing survival after LT and LR for patients with HCC meeting the Milan criteria. Meta-analyses and metaregression were conducted using random-effects models.Results: We screened 2,278 studies and included 35 studies with 18,421 patients. LR was associated with poorer OS [hazard ratio (HR) =1.44; 95% confidence interval (CI): 1.14-1.81; P<0.01] and DFS (HR =2.71; 95% CI: 2.23-3.28; P<0.01) compared to LT, with similar findings among intention-to-treat (ITT) studies. In uninodular disease, OS in LR was comparable to LT (P=0.13) but DFS remained poorer (HR =2.95; 95% CI: 2.30-3.79; P<0.01). By region, LR had poorer OS versus LT in North America and Europe (P≤0.01), but not Asia (P=0.25). LR had inferior survival versus LT in studies completed before 2010 (P=0.01), but not after 2010 (P=0.12). Cohorts that underwent enhanced surveillance had comparable OS after LT and LR (P=0.33), but cohorts undergoing usual surveillance had worse OS after LR (HR =1.95; 95% CI: 1.24-3.07; P<0.01).Conclusions: Mortality after LR for HCC is nearly 50% higher compared to LT. Survival between LR and LT were similar in uninodular disease. The risk of recurrence after LR is threefold that of LT.

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Primary Living-donor Liver Transplantation Is Not the Optimal Treatment Choice in Patients With Early Hepatocellular Carcinoma With Poor Tumor Biology

Cited by 10 publications

References 22 publications

Hepatocellular carcinoma: when is liver transplantation oncologically futile?

Hepatocellular carcinoma: when is liver transplantation oncologically futile?

Comparison of liver resection and living donor liver transplantation in patients with hepatocellular carcinoma within Milan criteria and well-preserved liver function

Liver resection versus liver transplantation for hepatocellular carcinoma within Milan criteria: a meta-analysis of 18,421 patients

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