Surgical treatment for early hepatocellular carcinoma: comparison of resection and liver transplantation

Abstract

Purpose: The optimum strategy, hepatic resection (HR) or liver transplantation (LT), for treatment of early hepatocellular carcinoma (HCC) associated with liver diseases of Child-Pugh A is far from established. The aim of this study was to compare and determine which strategy is optimal for HCC fulfilling the Milan criteria.

Methods: Consecutive data were collected in 1,018 HCC patients treated with HR and 89 HCC patients listed for LT (1 drop out for HCC progression) between January of 2003 and December of 2007.

Results: The independent prognostic factors identified by multivariate analysis were tumor size-plus-number, microscopic venous invasion, and operation type (LT or HR). When tumor size-plus-number was < or =4 or microscopic venous invasion was absent, there was no significant difference in overall survival (OS) between the LT and HR group. When tumor size-plus-number was >4 or microscopic venous invasion was present, OS was higher in the LT group.

Conclusions: Since the pathological microscopic venous invasion was not easily available before operation which is limitation for widespread clinical use, thus in practice, we concluded that, for early HCC associated with Child-Pugh A cirrhosis, when tumor size-plus-number is >4, LT provides the best cure; when it is < or =4, HR remains the initial treatment of choice.

Fig. 1

a Cumulative survival curves of the resection group (n = 1,018) and the transplantation group (n = 89). b Cumulative disease-free survival curves of the resection group (n = 1,018) and the transplantation group (n = 89)

Fig. 2

a Cumulative survival curves of patients with tumor size-plus-number ≤4 in the resection group (n = 540) and the transplantation group (n = 45). (P = 0.338). b Cumulative survival curves of patients with tumor size-plus-number >4 in the resection group (n = 478) and the transplantation group (n = 44) (P = 0.022). c Cumulative survival curves of patients without microscopic venous invasion in the resection group (n = 772) and the transplantation group (n = 54) (P = 0.133). d Cumulative survival curves of patients with microscopic venous invasion in the resection group (n = 246) and the transplantation group (n = 35) (P = 0.032)

Fig. 3

a Cumulative disease-free survival curves of patients with tumor size-plus-number ≤4 in the resection group (n = 540) and the transplantation group (n = 45). (P = 0.007). b Cumulative disease-free survival curves of patients with tumor size-plus-number >4 in the resection group (n = 478) and the transplantation group (n = 44). (P = 0.001). c Cumulative disease-free survival curves of patients without microscopic venous invasion in the resection group (n = 772) and the transplantation group (n = 54) (P = 0.001). d Cumulative disease-free survival curves of patients with microscopic venous invasion in the resection group (n = 246) and the transplantation group (n = 35) (P = 0.005)