title: The impact of liver transplantation after surgical treatment of hepatocellular carcinoma.
abstract: BACKGROUND
  The impact of liver transplantation (LTx) after surgical treatment for hepatocellular carcinoma (HCC) remains undefined. The aim of the current study was to assess the impact of LTx and of selection criteria for LTx on the survival of patients who underwent surgery for HCC.
  
  
  METHODS
  Between 2004 and 2009, 119 patients underwent surgical treatment for HCC. Cirrhosis was present in 85 patients. Of all patients, 77 fulfilled the Milan criteria, 88 the UCSF and 87 the up-to-7 criteria. Finally, 35 patients received an LTx, of whom 31 met the Milan, 33 the UCSF, and 33 the up-to-7 criteria. The relation between LTx and survival was evaluated using a Cox regression model with LTx as a time-dependent factor.
  
  
  RESULTS
  Median [95% confidence interval (CI)] disease-free survival (DFS) and overall survival (OS) of the entire patient population was 9.4 (7-12.2) and 49.1 (37.7-64) months, respectively. The 1, 3, and 5-year DFS vs. OS rates were 36, 3, and 0% vs. 84.7, 61.7, and 39.6%, respectively. Patients fulfilling the Milan criteria had a significantly better OS and DFS than those who had tumors beyond the Milan criteria (p < 0.047). No significant differences were observed in terms of OS between patients within vs. beyond the UCSF or up-to-7 criteria (p > 0.130). In multivariable analysis, cirrhotic patients who received an LTx had a better OS, with a hazard ratio equal to 0.25 (95% CI: 0.08-0.74; p < 0.01). LTx after surgery had a beneficial impact on both DFS and OS of patients in all the three selection criteria models of LTx (p < 0.031).
  
  
  CONCLUSIONS
  LTx after primary surgery seems to offer the best long-term survival for patients suffering from HCC in cirrhosis as well as for them who fulfill the Milan, UCSF, and up-to-7 criteria.
authors.affiliation: Department of Abdominal Surgery, University Hospitals Leuven , Leuven , Belgium.
authors.forename: Halit
authors.initials: H
authors.lastname: Topal
authors.affiliation: Department of Abdominal Surgery, University Hospitals Leuven , Leuven , Belgium.
authors.forename: Joyce
authors.initials: J
authors.lastname: Tiek
authors.affiliation: Department of Biostatistics, I-Biostat, Katholieke Universiteit Leuven en Hasselt , Leuven , Belgium.
authors.forename: Steffen
authors.initials: S
authors.lastname: Fieuws
authors.affiliation: Department of Transplantation Surgery, University Hospitals Leuven , Leuven , Belgium.
authors.forename: Jacques
authors.initials: J
authors.lastname: Pirenne
authors.affiliation: Department of Hepatology, University Hospitals Leuven , Leuven , Belgium.
authors.forename: Frederik
authors.initials: F
authors.lastname: Nevens
authors.affiliation: Department of Abdominal Surgery, University Hospitals Leuven , Leuven , Belgium.
authors.forename: Baki
authors.initials: B
authors.lastname: Topal
keywords: hepatocellular carcinoma; surgery; survival; transplantation