Survival advantage of primary liver transplantation for hepatocellular carcinoma within the up-to-7 criteria with microvascular invasion.
OBJECTIVE
Microvascular invasion of hepatocellular carcinoma (HCC) is considered a poor prognostic factor of liver resection (LR) and liver transplantation (LT), but its significance for lesions within the up-to-7 criteria is unclear. This study investigated the survival benefit of primary LT against LR for HCC with microvascular invasion and within the up-to-7 criteria.


METHODS
Adult patients who underwent LR or LT as the primary treatment for HCC were included for study. Patients with prior local ablation, neoadjuvant systemic chemotherapy, targeted therapy, positive resection margin, or metastatic spread were excluded.


RESULTS
There were 471 LR patients and 95 LT recipients (70 with living donor, 25 with deceased donor). Seventy-seven (81.1%) LT recipients had HCC within the up-to-7 criteria. Twenty-five (26.3%) LT recipients had HCC with either macrovascular (n= 4) or microvascular (n= 21) invasion. The 5-year survival rate was 85.7% for LT recipients with HCC within the up-to-7 criteria, unaffected by the presence or absence of vascular invasion (88.2 vs. 85.1%). The rate was comparable with that of LR patients with HCC without vascular invasion (81.2%,p0.227), but far superior to that of LR patients with lesions with vascular invasion (50.0%,p< 0.0001). Overall survivals were compromised by multiple tumors [odds ratio (OR) 1.902, confidence interval (CI) 1.374-2.633,p= 0.0001], vascular invasion (OR 2.678, CI 1.952-3.674,p< 0.0001), blood transfusion (OR 2.046, CI 1.337-3.131,p= 0.001), and being beyond the up-to-7 criteria (OR 1.457, CI 1.041-2.037,p= 0.028). LT was a favorable factor for survival (OR 0.243, CI 0.130-0.454,p< 0.0001).


CONCLUSIONS
Primary LT for HCC with microvascular invasion and within the up-to-7 criteria doubled the chance of cure as compared with LR.
State Key Laboratory for Liver Research, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, China ; Department of Surgery, The University of Hong Kong, Hong Kong, China.
See Ching
SC
Chan
State Key Laboratory for Liver Research, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, China ; Department of Surgery, The University of Hong Kong, Hong Kong, China.
Sheung Tat
ST
Fan
Department of Surgery, The University of Hong Kong, Hong Kong, China.
Kenneth S H
KS
Chok
Department of Surgery, The University of Hong Kong, Hong Kong, China.
Tan To
TT
Cheung
Department of Surgery, The University of Hong Kong, Hong Kong, China.
Albert C Y
AC
Chan
Department of Medicine, The University of Hong Kong, Hong Kong, China.
James Y Y
JY
Fung
State Key Laboratory for Liver Research, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, China ; Department of Surgery, The University of Hong Kong, Hong Kong, China.
Ronnie T P
RT
Poon
State Key Laboratory for Liver Research, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, China ; Department of Surgery, The University of Hong Kong, Hong Kong, China.
Chung Mau
CM
Lo