Outcome of HCC patients with tumor status within the Milan criteria after partial hepatectomy as the primary treatment

Abstract

Background: There is a recent tendency of offering liver transplantation for hepatocellular carcinoma (HCC) patients with tumor status within the Milan criteria but with preserved liver function. Yet, the outcome of such patients after partial hepatectomy has not been reported in detail. Objectives: To evaluate the outcome of HCC patients with tumor status within the Milan criteria after partial hepatectomy as the primary treatment. Methods: The prospectively documented data of 410 HCC patients with tumor status within the Milan criteria having partial hepatectomy as the primary treatment were reviewed. Their outcomes were compared with 51 HCC patients of the same tumor status having living donor liver transplantation (LDLT) as the primary treatment at the same center. Results: The patients were treated by major hepatectomy (n=124, 30.2%) or minor hepatectomy (n=286, 69.8%) and their hospital mortality rates were 5.6% and 1.4%, respectively. The overall 5-year survival rate was 69.3%. Patients with solitary tumor 5cm or less in diameter (n=385) had longer 5-year survival than patients with oligonodular tumors (tumor numbers 2-3, each 3cm or less in diameter, n=25) (70.8% vs. 46.3%, p=0.03). No difference in clinical, pathologic and operation factors was observed between the two groups. Patients with underlying chronic hepatitis (n=71) achieved a higher survival rate than patients with normal liver (n=26) or cirrhosis (n=313) (85.2% vs. 69.6% vs. 65%, p<0.05). Multivariate analysis identified major hepatectomy, lack of postoperative complications, negative resection margin and absence of microvascular infiltration to be predictors of favorable overall survival. The patients with solitary tumor 5cm or less in diameter having major hepatectomy without margin positivity (n=116) achieved a 5-year survival rate of 81.1%, which was comparable with that of LDLT patients of same tumor status (81.2%). Recurrence of HCC occurred in 205 (50%) patients. Treatment of recurrences in 181 patients resulted in prolongation of survival (median 44.36 months vs. 6.97 months of those without treatment, p<0.001). Compared with the patients undergoing LDLT, the time from operation to the first recurrence was similar (median 14.8 months vs. 24.6 months, p=0.498), but the post-treatment for recurrence 5-year survival rate was higher (35.3% vs. 0%, p = 0.009) than patients undergoing LDLT. Conclusion: Partial hepatectomy for patients with tumor status within the Milan criteria achieved a satisfactory 5-year survival rate, particularly in those with solitary tumors 5cm or less in diameter having major hepatectomy and negative margin and those with underlying chronic hepatitis. Patients with oligonodular tumors had worse survival and might benefit from liver transplantation as the primary treatment.