The role of liver transplantation or resection for patients with early hepatocellular carcinoma.
Liver resection (LR) and liver transplantation (LT) are curative treatments for early hepatocellular carcinoma (HCC), although their performance remains debated. We compared the survival of patients with HCC conforming to the Milan criteria (MC) after LT and LR and analyzed factors affecting clinical outcomes. Between January 2006 and January 2013, 65 and 184 patients received LT and LR for HCCs fulfilling the MC, respectively. Overall survival (OS) and disease-free survival (DFS) rates were compared between the two groups. To investigate effects of liver function and living donor liver transplantation (LDLT) on survival, two subgroup analyses were performed and associations with OS and DFS were examined. We found that OS rates were higher after LT than after LR since 3 years postoperatively. DFS rates were significantly better after LT than after LR. Performance of LR, vascular invasion, and tumor multiplicity were associated with poor DFS, and factors affecting OS included the presence of vascular invasions, liver cirrhosis, and tumor multiplicity. In conclusion, despite of the effects of tumor characteristics on clinical outcomes, LT, including LDLT, should be considered the treatment of choice for patients with HCCs who met the MC. The role of LR is to identify poor prognostic factors through pathological examination.
Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.|Division of General Surgery, Department of Surgery, Tungs' Taichung MetroHarbor Hospital, Taichung, Taiwan.
Kuan-Chun
KC
Hsueh
Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, 325, Sec. 2, Chen-Kung Rd, Neihu 114, Taipei, Taiwan.
Ting-Ying
TY
Lee
Cancer Center, Tungs' Taichung MetroHarbor Hospital, Taichung, Taiwan.
Chew-Teng
CT
Kor
Division of Hepato-Gastroenterology, Department of Internal Medicine, Tungs' Taichung MetroHarbor Hospital, Taichung, Taiwan.
Tsung-Ming
TM
Chen
Division of General Surgery, Department of Surgery, Tungs' Taichung MetroHarbor Hospital, Taichung, Taiwan.
Tzu-Ming
TM
Chang
Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.|Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan.
Shun-Fa
SF
Yang
Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, 325, Sec. 2, Chen-Kung Rd, Neihu 114, Taipei, Taiwan. albert0920@yahoo.com.tw.
Chung-Bao
CB
Hsieh
D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012307:Risk Factors; D016896:Treatment Outcome
Hepatocellular carcinoma; Liver resection; Liver transplantation