Transplanting resectable hepatocellular carcinoma - an once for all treatment modality

Abstract

Objectives: We sought to define the best surgical treatment for transplantable hepatocellular carcinoma (HCC). Method: This is a retrospective, propensity score (PS) matched, intention-to-treat analysis comparing the long-term outcome between HCC patients who received hepatectomy (LR) and liver transplantation (LT) as primary surgical treatment from 1995-2014. Patients with HCC beyond Milan‘s criteria, recurrent HCC, and positive resection margin were excluded. Independent factors for survival were identified using cox-regression model. Results: There were 766 eligible patients. Significant differences in age, presence of comorbidity, model of end-stage liver disease (MELD) score, alpha fetoprotein (AFP), albumin, tumour largest diameter, number of tumour, and presence of vascular invasion were noted between resection and transplant group patients. After PS matching, there were 160 and 40 patients in the LR and LT groups respectively. Majority of the patients were male (81.5%) and hepatitis B carrier (88%). The median age and follow-up time for the matched population was 55 years old and 71 months respectively. Patients in the LR group had significantly higher HCC recurrence rate (63.1% vs 15.0%, P< 0.001). Albumin-bilirubin index (P=0.009), microvascular permeation (P=0.004) and transplantation (P< 0.001) were independent factors associated with recurrent HCC. Patient‘s age (P=0.004), presence of microvascular permeation (P< 0.001), and LT (P=0.04) were independent factors associated with overall survival. Patients who receive LT had a superior 5-year disease free and overall survival compared with those who had LR (81.6% vs 66.7%, P=0.021 and 79.5% vs 40.3%, P< 0.001 respectively). Conclusion: Liver transplantation gives the best chance of cure in patients with transplantable HCC.