title: Liver transplantation is an alternative treatment of hepatocellular carcinoma beyond the Milan criteria.
abstract: BACKGROUND
  The decision to perform liver transplantation (LT) or liver resection (LR) for patients with hepatocellular carcinoma (HCC) who are beyond the Milan criteria remains controversial.
  
  
  METHODS
  We retrospectively analyzed outcome data for 179 patients with HCC beyond the Milan criteria who were treated with LR (n = 135) or LT (n = 44). Univariate and multivariate Cox proportional hazard models were established. Kaplan-Meier survival curves were generated, and a log-rank test was performed to compare group survival status.
  
  
  RESULTS
  Patients who underwent LR group were significantly older, had a lower TNM stage, and were more likely to have unilateral disease and noncirrhotic liver. Significantly more patients in the LR group had recurrence (53.3% vs 29.5%) or died (61.5% vs 43.2%) than patients in the LT group. Recurrence-free survival rates were 11.9% for the LR group and 61.5% for the LT group. The median overall survival duration showed no statistically difference between the LR group (28.0 months) and the LT group (50.0 months).
  
  
  CONCLUSIONS
  LT may be the better choice for patients with HCC beyond the Milan criteria.
authors.affiliation: Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Hsiu-Lung
authors.initials: HL
authors.lastname: Fan
authors.forename: Teng-Wei
authors.initials: TW
authors.lastname: Chen
authors.forename: Chung-Bao
authors.initials: CB
authors.lastname: Hsieh
authors.forename: Hsiang-Chun
authors.initials: HC
authors.lastname: Jan
authors.forename: Sheng-Chuan
authors.initials: SC
authors.lastname: His
authors.forename: Chan
authors.initials: C
authors.lastname: De-Chuan
authors.forename: Chi-Hong
authors.initials: CH
authors.lastname: Chu
authors.forename: Jyh-Cherng
authors.initials: JC
authors.lastname: Yu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult