title: Resection or transplant-listing for solitary hepatitis C-associated hepatocellular carcinoma: an intention-to-treat analysis.
abstract: OBJECTIVE
  The relative roles of liver resection (LR) and liver transplantation (LT) in the treatment of a solitary hepatocellular carcinoma (HCC) remain unclear. This study was conducted to provide a retrospective intention-to-treat comparison of these two curative therapies.
  
  
  METHODS
  Records maintained at the study centre for all patients treated with LR or listed for LT for hepatitis C-associated HCC between January 2002 and December 2007 were reviewed. Inclusion criteria required: (i) an initial diagnosis of a solitary HCC lesion measuring ≤ 5 cm, and (ii) Child-Pugh class A or B cirrhosis. The primary endpoint analysed was intention-to-treat survival.
  
  
  RESULTS
  A total of 75 patients were listed for transplant (LT-listed group) and 56 were resected (LR group). Of the 75 LT-listed patients, 23 (30.7%) were never transplanted because they were either removed from the waiting list (n = 13) or died (n = 10). Intention-to-treat median survival was superior in the LR group compared with the LT-listed group (61.8 months vs. 30.6 months), but the difference did not reach significance. Five-year recurrence was higher in the LR group than in the 52 LT patients (71.5% vs. 30.5%; P < 0.001).
  
  
  CONCLUSIONS
  In the context of limited donor organ availability, partial hepatectomy represents an efficacious primary approach in properly selected patients with hepatitis C-associated HCC.
authors.affiliation: Recanati/Miller Transplantation Institute, Mount Sinai Medical Center, New York, NY 10029, USA.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Sogawa
authors.forename: Brian
authors.initials: B
authors.lastname: Shrager
authors.forename: Ghalib
authors.initials: G
authors.lastname: Jibara
authors.forename: Parissa
authors.initials: P
authors.lastname: Tabrizian
authors.forename: Sasan
authors.initials: S
authors.lastname: Roayaie
authors.forename: Myron
authors.initials: M
authors.lastname: Schwartz
mesh_terms: D000368:Aged; D000465:Algorithms; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000401:mortality / Q000601:surgery* / Q000821:virology; D005260:Female; D006498:Hepatectomy; D006526:Hepatitis C / Q000150:complications*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery* / Q000821:virology; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D014850:Waiting Lists