Early and resectable HCC: Definition and validation of a subgroup of patients who could avoid liver transplantation.
BACKGROUND
Liver transplantation (LT) remains the best curative option for early hepatocellular carcinoma (HCC) but is limited by the ongoing graft shortage. The present study aimed at defining the population in which primary liver resection (LR) could represent the best alternative to LT.


METHODS
An exploration set of 357 HCC patients (LR n = 221 and LT n = 136) operated between 2000-2012 was used in order to identify factors associated with survival following LR and define a good prognosis (GP) group for which LR may challenge the results of upfront LT. These factors were validated in an external validation set of 565 HCC patients operated at another center (LR n = 287 LR and LT n = 278).


RESULTS
In the exploration set, factors associated with survival on multivariate analysis were a solitary lesion, a diameter <50 mm, a well-moderately differentiated lesion, the absence of microvascular invasion, and preoperative AST level <2N. Thirty-nine patients (18%) displayed all these criteria and constituted the GP patients. Overall survivals at 1, 3, and 5 years did not significantly differ between GP resected patients, and the in Milan transplanted patients (93, 80.4, and 80.4% vs. 86.9, 82, and 78.8%, P = 0.79). In the validation cohort, patients with GP factors of survival still displayed better overall survivals than those without (P = 0.036) but also displayed better survivals than in Milan HCC transplanted patients (P = 0.005).


CONCLUSIONS
In a group of early HCC patients gathering all factors of GP, primary LR achieves at least similar survival as upfront LT and should be the approach of choice.
Departments of Hepatobiliary Surgery and Liver Transplantation, Hôpital Pitié Salpêtrière, Assistance Publique Hopitaux de Paris, Paris, France. olivier.scatton@psl.aphp.fr.|Université Pierre et Marie Curie, Paris 6. olivier.scatton@psl.aphp.fr.
Olivier
O
Scatton
Departments of Hepatobiliary Surgery and Liver Transplantation, Hôpital Pitié Salpêtrière, Assistance Publique Hopitaux de Paris, Paris, France.
Claire
C
Goumard
Department of Hepatobiliary surgery and Liver Transplantation, Hopital Beaujon, Assistance Publique Hopitaux de Paris, Paris, France.
Francois
F
Cauchy
Université Pierre et Marie Curie, Paris 6.|Department of Hepatology, Hopital Pitié Salpêtrière, Assistance Publique Hopitaux de Paris, Paris, France.
Laetitia
L
Fartoux
Departments of Hepatobiliary Surgery and Liver Transplantation, Hôpital Pitié Salpêtrière, Assistance Publique Hopitaux de Paris, Paris, France.
Fabiano
F
Perdigao
Université Pierre et Marie Curie, Paris 6.|Department of Pathology, Hopital Pitié Salpêtrière, Assistance Publique Hopitaux de Paris, Paris, France.
Filomena
F
Conti
Université Pierre et Marie Curie, Paris 6.|Department of Pathology, Hopital Pitié Salpêtrière, Assistance Publique Hopitaux de Paris, Paris, France.
Yvon
Y
Calmus
Department of Biostatistics, Hopital Saint Antoine, Assistance Publique Hopitaux de Paris, Paris, France.
Pierre Yves
PY
Boelle
Department of Hepatobiliary surgery and Liver Transplantation, Hopital Beaujon, Assistance Publique Hopitaux de Paris, Paris, France.
Jacques
J
Belghiti
Université Pierre et Marie Curie, Paris 6.|Department of Hepatology, Hopital Pitié Salpêtrière, Assistance Publique Hopitaux de Paris, Paris, France.
Olivier
O
Rosmorduc
Departments of Hepatobiliary Surgery and Liver Transplantation, Hôpital Pitié Salpêtrière, Assistance Publique Hopitaux de Paris, Paris, France.|Université Pierre et Marie Curie, Paris 6.
Olivier
O
Soubrane
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery*; D002648:Child; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D055815:Young Adult
early hepatocellular carcinoma; good prognosis group; hepatocellular carcinoma; liver resection; liver transplantation; patient selection