Justification of choosing liver resection or liver transplantation for hepatocellular carcinoma within Milan and UCSF criteria with normal, medium, high and very high AFP

Abstract

Introduction: Liver transplantation (LT) is the best treatment option for hepatocellular carcinoma (HCC). This study aimed to compare the long-term outcome of liver resection (LR) and LT with different levels of AFP. Methods: Prospectively collected data of patients suffering from HCC who had undergone either primary LR or LT at our hospital from 1995 to 2017 were reviewed. Tumors which were within Milan or UCSF criteria were included. They were stratified according to level of AFP, normal (< 10ng/mL), medium (≥ 10 to < 400 ng/mL), high (≥ 400 to < 1000 ng/mL) and very high (≥ 1000 ng/mL). The Kaplan-Meier method was used for survival analysis and the log-rank test was used for survival comparison. Results: During the study period, there were 911 patients underwent LR and 196 patients underwent LT. LR patients had better liver function, better Child grading, creatinine, platelet, INR and liver function test (p< 0.001). Patient underwent LR had fewer complications and shorter hospital stay (8 vs 16 days). There was no difference in hospital mortality. 3% (p=0.029) patients in LR had margin involvement. Patients in LT who had normal and medium level of AFP had better 5-year disease-free and overall survival (LR >72.3% vs LT 86.8%, p< 0.001). However, for high to very high AFP level, there was no difference in overall survival. Multivariate analysis suggested the size and number of tumor, and the grouping of AFP levels were the independent predictors of the overall survival. An equation was further formulated to predict the overall survival after different surgical treatments. Conclusion: LT offered better survival than LR for patients who suffered from HCC with normal and medium AFP. However, for those with high and very high AFP, the overall survival is going to be poor anyway, offering LT might not be beneficial.