title: Single HCC in cirrhotic patients: liver resection or liver transplantation? Long-term outcome according to an intention-to-treat basis.
abstract: BACKGROUND
  Compensated cirrhotic patients with single hepatocellular carcinoma (HCC) ≤5 cm may benefit from both liver resection (LR) and liver transplantation (LT); however, the better 10-year actuarial survival of the two treatments remains unclear. We aimed to assess the long-term outcome of cirrhotic patients with single HCC ≤5 cm treated either with LR or LT on an intention-to-treat basis.
  
  
  METHODS
  A total of 217 cirrhotic patients with single HCC ≤5 cm were evaluated at our department: 95 were treated with LR (LR group), and 122 were included on the waiting list for LT (LT group). Patients in the LR group were divided into very early HCC (tumor size ≤2 cm) and early HCC (tumor size >2 cm). Median follow-up was 5.3 (range 0.1-18) years.
  
  
  RESULTS
  Tumor recurrence was 72 % in the LR group versus 16 % in the LT group (p < 0.001). 1-, 5-, and 10-year cumulative risk of recurrence was 18, 69, and 83 % in the LR group versus 4, 18, and 20 % in the LT group (p < 0.001). Ten-year actuarial survival was 33 % in the LR group versus 49 % in the LT group (p = 0.002). At HCC recurrence, 27.3 % were included on the waiting list for salvage transplantation (very early HCC group) versus 15.1 % (early HCC group) (p = 0.2). After salvage transplantation, HCC recurrence was 0 % (very early HCC group) versus 40 % (early HCC group) (p = 0.2). No significant differences were observed in 1-, 5-, and 10-year actuarial survival between the very early HCC group and the LT group (95, 55, and 50 % vs. 82, 62, and 50 %).
  
  
  CONCLUSIONS
  LR should be the treatment of choice for cirrhotic patients with very early HCC.
authors.affiliation: Department of HBP Surgery and Transplantation, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain. sapisochin@me.com
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Sapisochin
authors.forename: Lluis
authors.initials: L
authors.lastname: Castells
authors.forename: Cristina
authors.initials: C
authors.lastname: Dopazo
authors.forename: Itxarone
authors.initials: I
authors.lastname: Bilbao
authors.forename: Beatriz
authors.initials: B
authors.lastname: Minguez
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: Lázaro
authors.forename: Helena
authors.initials: H
authors.lastname: Allende
authors.forename: Joaquin
authors.initials: J
authors.lastname: Balsells
authors.forename: Mireia
authors.initials: M
authors.lastname: Caralt
authors.forename: Ramón
authors.initials: R
authors.lastname: Charco
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000209:etiology / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000401:mortality*; D006801:Humans; D033182:Intention; D008103:Liver Cirrhosis / Q000150:complications* / Q000401:mortality / Q000628:therapy; D008113:Liver Neoplasms / Q000209:etiology / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016031:Liver Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000401:mortality; D009367:Neoplasm Staging; D011183:Postoperative Complications; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D015996:Survival Rate