The role of liver transplantation or resection for patients with early hepatocellular carcinoma

Abstract

Liver resection (LR) and liver transplantation (LT) are curative treatments for early hepatocellular carcinoma (HCC), although their performance remains debated. We compared the survival of patients with HCC conforming to the Milan criteria (MC) after LT and LR and analyzed factors affecting clinical outcomes. Between January 2006 and January 2013, 65 and 184 patients received LT and LR for HCCs fulfilling the MC, respectively. Overall survival (OS) and disease-free survival (DFS) rates were compared between the two groups. To investigate effects of liver function and living donor liver transplantation (LDLT) on survival, two subgroup analyses were performed and associations with OS and DFS were examined. We found that OS rates were higher after LT than after LR since 3 years postoperatively. DFS rates were significantly better after LT than after LR. Performance of LR, vascular invasion, and tumor multiplicity were associated with poor DFS, and factors affecting OS included the presence of vascular invasions, liver cirrhosis, and tumor multiplicity. In conclusion, despite of the effects of tumor characteristics on clinical outcomes, LT, including LDLT, should be considered the treatment of choice for patients with HCCs who met the MC. The role of LR is to identify poor prognostic factors through pathological examination.

Huge hepatocellular carcinoma greater than 10 cm in diameter worsens prognosis by causing distant recurrence after curative resection

“…The latest, large prospective randomized control study using sorafenib failed to demonstrate efficacy as adjuvant systemic chemotherapy; it was probably due to this study included patients with a relatively low risk for recurrence [32]. This trial was designed to target the HCC within Milan criteria [33], though the prognosis of these patients was reported relatively better as 5-year RFS has been 46.6-57.2% [34,35]. The prognosis is fairly good compared to our cases with HCC >10 cm with 14.2% RFS and these patients are facing extra-hepatic recurrence after hepatectomy.…”

<p>Cyclin-dependent kinase inhibitor 2B gene is associated with the sensitivity of hepatoma cells to Sorafenib</p>

“…However, there is still no effective treatment for HCC. For HCC patients at an early stage, liver resection and liver transplantation are preferred treatment methods 2,3. Although the liver has a strong compensatory function, the early symptoms of HCC are not easily found and lack specificity, and most HCC patients are diagnosed at the late stage of the disease 4,5.…”

KCNQ1OT1 contributes to sorafenib resistance and programmed death‑ligand‑1‑mediated immune escape via sponging miR‑506 in hepatocellular carcinoma cells

“…In recent years, although significant progress has been made in the treatment of HCC, the overall prognosis remains dismal ( 2 ). Surgery is the first and most effective method for the treatment of patients with HCC; however, chemotherapy is considered the most appropriate method for some patients with advanced disease ( 3 , 4 ). Sorafenib is a multi-target anti-tumor drug, which is currently the first-line treatment drug for patients with advanced HCC ( 5 ).…”