title: Liver transplantation, liver resection, and transarterial chemoembolization for hepatocellular carcinoma in cirrhosis: which is the best oncological approach?
abstract: The aim of the study was to evaluate our institutional experience with monotherapies for hepatocellular carcinoma (HCC) in the setting of cirrhosis. A retrospective cohort study was carried out at the tertiary care academic referral center and involved 185 consecutive HCC patients with cirrhosis and no previous treatment who underwent resection (n = 61), transarterial chemoembolization (TACE) (n = 64), or liver transplantation (LT) (n = 60). Long-term survival and survival according to the Milan criteria were the main outcomes measured. Median survival after resection, TACE, and LT was 11, 14, and 23 months, respectively. Five-year cumulative survival after resection, TACE, and LT was 23, 10, and 59%, respectively (P = 0.001). Five-year cumulative disease-free survival after resection and LT was 15% and 77%, respectively (P = 0.002). The presence of complications in the resection group (P = 0.004), MELD score (P = 0.0003), and maximum tumor diameter (P = 0.05) in the TACE group, and tumor grade (P = 0.01) and complications (P = 0.004) in the LT group were found to be independent predictors of survival. Five-year survival for patients within the Milan criteria after resection, TACE, and LT was 26, 37, and 66%, respectively. Five-year survival for patients outside the Milan criteria for patients undergoing LT was 53%. The results suggest that LT represents the best oncological treatment option for patients with HCC in the setting of cirrhosis, even for those beyond the Milan criteria. Considering the scarcity of available organs, liver resection remains the best alternative option. TACE remains a potential therapy in patients within the Milan criteria, where it may be more beneficial than resection.
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany. sotiropoulos@ach.klinik.uni-mainz.de
authors.forename: Georgios C
authors.initials: GC
authors.lastname: Sotiropoulos
authors.forename: Nina
authors.initials: N
authors.lastname: Drühe
authors.forename: George
authors.initials: G
authors.lastname: Sgourakis
authors.forename: Ernesto P
authors.initials: EP
authors.lastname: Molmenti
authors.forename: Susanne
authors.initials: S
authors.lastname: Beckebaum
authors.forename: Hideo A
authors.initials: HA
authors.lastname: Baba
authors.forename: Gerald
authors.initials: G
authors.lastname: Antoch
authors.forename: Philip
authors.initials: P
authors.lastname: Hilgard
authors.forename: Arnold
authors.initials: A
authors.lastname: Radtke
authors.forename: Fuat H
authors.initials: FH
authors.lastname: Saner
authors.forename: Silvio
authors.initials: S
authors.lastname: Nadalin
authors.forename: Andreas
authors.initials: A
authors.lastname: Paul
authors.forename: Massimo
authors.initials: M
authors.lastname: Malagó
authors.forename: Christoph E
authors.initials: CE
authors.lastname: Broelsch
authors.forename: Hauke
authors.initials: H
authors.lastname: Lang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D015331:Cohort Studies; D005260:Female; D006498:Hepatectomy; D006499:Hepatic Artery; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome