title: Surgical management of early-stage hepatocellular carcinoma: resection or transplantation?
abstract: BACKGROUND
  The surgical management of hepatocellular carcinoma in patients with well-compensated cirrhosis is controversial. The purpose of the current study was to compare the outcome of patients with well-compensated cirrhosis and early stage hepatocellular carcinoma treated with initial hepatic resection versus transplantation.
  
  
  METHODS
  Between 1985 and 2008, 245 patients underwent hepatic resection, and 134 patients underwent liver transplantation for early stage hepatocellular carcinoma. All patients had well-compensated cirrhosis. Prognostic factors were evaluated using univariate and multivariate analyses; survival was calculated using the Kaplan-Meier method.
  
  
  RESULTS
  Compared with transplantation, patients undergoing resection had larger tumors and a higher incidence of microscopic vascular invasion. Transplantation was associated with better 5-year disease-free and overall survival compared with resection. Hepatitis status, presence of microscopic vascular invasion, and tumor size were predictors for recurrence, while the presence of microscopic vascular invasion and tumor size conferred an increased risk of death. The disease-free survival advantage with transplantation was more pronounced in hepatitis C patients compared with non-hepatitis and hepatitis B patients. The overall survival advantage with transplantation persisted in cases of solitary lesions < or = 3 cm, but was attenuated in patients with a MELD score < or = 8.
  
  
  CONCLUSIONS
  In well-compensated cirrhotic patients with early stage hepatocellular carcinoma, transplantation was associated with longer disease-free and overall survival. Patients undergoing resection did, however, have tumors with more advanced pathologic features. Patients best suited for initial resection as the treatment of hepatocellular carcinoma were those with a MELD score </= 8 without evidence of hepatitis.
authors: Department of Surgery, University of Maryland Medical Center, Baltimore, MD, USA.
authors: Emily C
authors: EC
authors: Bellavance
authors: Kimberly M
authors: KM
authors: Lumpkins
authors: Gilles
authors: G
authors: Mentha
authors: Hugo P
authors: HP
authors: Marques
authors: Lorenzo
authors: L
authors: Capussotti
authors: Carlo
authors: C
authors: Pulitano
authors: Pietro
authors: P
authors: Majno
authors: Paulo
authors: P
authors: Mira
authors: Laura
authors: L
authors: Rubbia-Brandt
authors: Alessandro
authors: A
authors: Ferrero
authors: Luca
authors: L
authors: Aldrighetti
authors: Steven
authors: S
authors: Cunningham
authors: Nadia
authors: N
authors: Russolillo
authors: Benjamin
authors: B
authors: Philosophe
authors: Eduardo
authors: E
authors: Barroso
authors: Timothy M
authors: TM
authors: Pawlik
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery*; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008103:Liver Cirrhosis / Q000601:surgery; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D016019:Survival Analysis; D016896:Treatment Outcome