Survival analysis of patients with stage I and II hepatocellular carcinoma after a liver transplantation or liver resection

• Published in: HPB (Oxford, England) Vol. 16; no. 12; pp. 1102 - 1109
• Main Authors: Seshadri, Ramanathan M, Besur, Siddesh, Niemeyer, David J, Templin, Megan, McKillop, Iain H, Swan, Ryan Z, Martinie, John B, Russo, Mark W, Iannitti, David A
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.12.2014; Wiley Subscription Services, Inc; BlackWell Publishing Ltd
• Subjects: Carcinoma, Hepatocellular - mortality; Carcinoma, Hepatocellular - pathology; Carcinoma, Hepatocellular - surgery; Databases, Factual; Female; Gastroenterology and Hepatology; Hepatectomy - adverse effects; Hepatectomy - mortality; Humans; Kaplan-Meier Estimate; Liver cancer; Liver cirrhosis; Liver Neoplasms - mortality; Liver Neoplasms - pathology; Liver Neoplasms - surgery; Liver Transplantation - adverse effects; Liver Transplantation - mortality; Male; Middle Aged; Neoplasm Staging; Original; Patient Selection; Proportional Hazards Models; Retrospective Studies; Survival analysis; Time Factors; Transplants & implants; Treatment Outcome; United States - epidemiology; United States
• ISSN: 1365-182X; 1477-2574
• DOI: 10.1111/hpb.12300

Abstract Introduction Liver transplantation (LT) is a treatment option in select patients with hepatocellular carcinoma (HCC). The aim of the present study was to compare survival in Stage I or II HCC patients undergoing either liver transplant (LT) or a liver resection (LR). Method The study is a retrospective analysis of the National Cancer Data Base (1998–2011). In total, 148 882 patients with liver cancer were identified, of which 5-year survival data (1998–2006) were available for 64 227 patients. Patients were stratified by the American Joint Committee on Cancer (AJCC) clinical stage I and II. Kaplan–Meier curves and log-rank tests were used for statistical analysis. Results 3340 HCC patients met analysis criteria. Among stage I HCC, 860 had LT and 871 had LR. Among stage II HCC, 833 had LT and 776 LR. In stage I patients the median survival for LT and LR were 127.9 and 56.7 months, respectively, ( P < 0.0001) and in stage II patients the median survival was 110.8 and 42.8 months ( P < 0.0001). Unlike LT patients, LR patients with Stage I HCC had a longer median survival compared with Stage II patients ( P = 0.0002). Conclusion Liver transplantation offers a survival advantage compared with a liver resection among patients with Stage I and II HCC. LT is the best surgical treatment for early stage (I/II) HCC in patients with advanced fibrosis or cirrhosis, whereas LR provides equivalent outcomes to LT in patients without advanced fibrosis and should be considered as the first surgical option.