title: Survival benefit of transplantation for recurrence of hepatocellular carcinoma after liver resection.
abstract: BACKGROUND
  Liver transplantation (LT) for hepatocellular carcinoma (HCC) can be used for tumor recurrence after liver resection (LR) both for initially transplant-eligible patients as conventional salvage therapy (ST) and for non-transplant-eligible patients (beyond Milan criteria) with a goal of downstaging (DW). The aim of this study was to compare the intention-to-treat (ITT) survival rates of patients who are listed for LT, according to these two strategies.
  
  
  METHODS
  We analyzed a prospective database of 399 consecutive patients who underwent hepatic resection for HCC from 2002 to 2011 to identify patients included in the waiting list for tumor recurrence. Intention-to-treat (ITT) survivals were compared with those of patients resected for HCC within and beyond Milan criteria in the same period and not included in the LT waiting list.
  
  
  RESULTS
  The study group consisted of 42 patients, 28 in the ST group (within Milan) and 14 in the DW group (beyond Milan). The 5-year ITT survival rate was similar between the 2 groups, being 64% for ST and 60% for DW (P=.84). Twenty-five patients (15 ST and 10 DW) underwent LT, 13 (10 ST and 3 DW) were still awaiting LT, 4 (3 ST and 1 DW) dropped out of the waiting list because of tumor progression, and 7 (5 ST [33%] and 2 DW [20%]) had tumor recurrence. The 5-year ITT survival of ST patients was similar to that of 252 in-Milan HCC patients resected only (P=.3), whereas 5-year ITT survival of DW patients was significantly higher (P<.01) than that of 105 beyond-Milan HCC patients resected only.
  
  
  CONCLUSIONS
  LR seems to be a safe and effective therapy both as alternative to transplantation and as downstaging strategy for intermediate-advanced HCC. The survival benefit of salvage LT, however, seems to be higher in the 2nd than in the 1st group.
authors.affiliation: Unità di Chirurgia Epatobiliare e Trapianto Epatico, Azienda, Università di Padova, Padua, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Tuci
authors.affiliation: Unità di Chirurgia Epatobiliare e Trapianto Epatico, Azienda, Università di Padova, Padua, Italy. Electronic address: alessandro.vitale@unipd.it.
authors.forename: A
authors.initials: A
authors.lastname: Vitale
authors.affiliation: Unità di Emergenze Trapiantologiche, Azienda, Università di Padova, Padua, Italy.
authors.forename: F
authors.initials: F
authors.lastname: D'Amico
authors.affiliation: Unità di Chirurgia Epatobiliare e Trapianto Epatico, Azienda, Università di Padova, Padua, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Gringeri
authors.affiliation: Unità di Chirurgia Epatobiliare e Trapianto Epatico, Azienda, Università di Padova, Padua, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Neri
authors.affiliation: Unità di Chirurgia Epatobiliare e Trapianto Epatico, Azienda, Università di Padova, Padua, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Zanus
authors.affiliation: Unità di Chirurgia Epatobiliare e Trapianto Epatico, Azienda, Università di Padova, Padua, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Bassi
authors.affiliation: Unità di Chirurgia Epatobiliare e Trapianto Epatico, Azienda, Università di Padova, Padua, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Polacco
authors.affiliation: Unità di Chirurgia Epatobiliare e Trapianto Epatico, Azienda, Università di Padova, Padua, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Boetto
authors.affiliation: Unità di Chirurgia Epatobiliare e Trapianto Epatico, Azienda, Università di Padova, Padua, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Lodo
authors.affiliation: Unità di Trapianto Multiviscerale, Azienda, Università di Padova, Padua, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Germani
authors.affiliation: Unità di Trapianto Multiviscerale, Azienda, Università di Padova, Padua, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Burra
authors.affiliation: Unità di Emergenze Trapiantologiche, Azienda, Università di Padova, Padua, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Angeli
authors.affiliation: Unità di Chirurgia Epatobiliare e Trapianto Epatico, Azienda, Università di Padova, Padua, Italy.
authors.forename: U
authors.initials: U
authors.lastname: Cillo
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000601:surgery*; D005260:Female; D006498:Hepatectomy; D006801:Humans; D057194:Intention to Treat Analysis; D008113:Liver Neoplasms / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000601:surgery*; D016879:Salvage Therapy / Q000401:mortality; D015996:Survival Rate; D016896:Treatment Outcome