title: Liver transplantation versus surgical resection for HCC meeting the Milan criteria: A propensity score analysis.
abstract: The optimal treatment (liver transplantation [LT] vs surgical resection [SR]) for early-stage hepatocellular carcinoma (HCC) remains controversial.A total of 209 SR patients and 129 LT patients were identified at our institution. After eliminating 27 patients with Child-Pugh C, the data from 209 SR patients and 102 LT patients were analyzed using a propensity score matching (PSM) model. Forty-six pairs were generated. A subgroup analysis was conducted based on the alpha-fetoprotein (AFP) level or platelet count (PLT). A survival analysis was performed using the Kaplan-Meier method.Gender, satellite lesions, and the treatment method were predictors of HCC recurrence. The Ishak score and treatment methods were associated with long-term survival after surgery. Before PSM, LT patients had a better prognosis than those treated by SR. Among HCC patients with childhood A/B cirrhosis, after PSM, SR achieved similar overall survival outcomes compared with LT. LT and SR resulted in comparable long-term survival for patients with or without thrombocytopenia. Patients with an AFP ≥ 400 ng/mL might achieve more survival benefits from LT.Our propensity score model provided evidence that, compared with transplantation, surgical resection could result in comparable long-term survival for resectable early-stage HCC patients, except for the AFP ≥ 400 ng/mL HCC subgroup. Surgical resection might not be a contraindication for early-stage HCC patients with thrombocytopenia due to their similar prognosis after transplantation.
authors.affiliation: Department of Liver Surgery & Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Jun-Yi
authors.initials: JY
authors.lastname: Shen
authors.forename: Chuan
authors.initials: C
authors.lastname: Li
authors.forename: Tian-Fu
authors.initials: TF
authors.lastname: Wen
authors.forename: Lv-Nan
authors.initials: LN
authors.lastname: Yan
authors.forename: Bo
authors.initials: B
authors.lastname: Li
authors.forename: Wen-Tao
authors.initials: WT
authors.lastname: Wang
authors.forename: Jia-Yin
authors.initials: JY
authors.lastname: Yang
authors.forename: Ming-Qing
authors.initials: MQ
authors.lastname: Xu
authors.forename: Tholakkara
authors.initials: T
authors.lastname: Nazar Highness
mesh_terms: D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000473:pathology* / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000097:blood / Q000473:pathology* / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010976:Platelet Count; D057216:Propensity Score; D015996:Survival Rate; D000509:alpha-Fetoproteins / Q000378:metabolism
chemical_list: D000509:alpha-Fetoproteins