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. 2021 Jun;10(3):308-314.
doi: 10.21037/hbsn.2020.03.09.

Liver transplantation: would it be the best and last chance of cure for hepatocellular carcinoma with major venous invasion?

Ka Wing Ma  1 , Albert Chi Yan Chan  1 , Kenneth Siu Ho Chok  1 , Wong Hoi She  1 , Tan To Cheung  1 , Wing Chiu Dai  1 , James Yan Yue Fung  2 , Chung Mau Lo  1
Affiliations

Liver transplantation: would it be the best and last chance of cure for hepatocellular carcinoma with major venous invasion?

Ka Wing Ma et al. Hepatobiliary Surg Nutr. 2021 Jun.

Abstract

Background: Hepatocellular carcinoma (HCC) with portal vein tumour thrombus (PVTT) signifies advanced disease, whether LT confers any survival superiority over resection remains uncertain.

Methods: A propensity score matched (PSM) analysis of liver transplantation (LT) and liver resection (LR) for HCC with PVTT was performed.

Results: A consecutive series of 88 patients who received either LT (10 DDLTs and 3 LDLTs) or LR (n=75) respectively were recruited. Before PSM, the LT group has a higher MELD score (17.3 vs. 7.8, P<0.001), lower serum AFP levels (96 vs. 2,164 ng/mL, P=0.017) and smaller tumour size (4 vs. 10 cm, P<0.001). The 5-year overall survival for LT and LR were 55.4% and 15.9% respectively (P=0.007). After matching for serum AFP levels and tumour size, 1-, 3- and 5-year overall survival for LT were 81 ng/mL, 3.9 cm, 80%, 70% and 70% and the corresponding rates for LR were 1,417 ng/mL, 5.3 cm, 51.8%, 19,6% and 9.8% (P value =0.12, 0.27 and 0.009 respectively).

Conclusions: LT is associated with significantly better oncological outcomes in HCC patients with PVTT involving the lobar or segmental level. A modest expansion of selection criteria to include small HCC with segmental PVTT should be considered.

Keywords: Liver transplantation (LT); liver resection (LR); portal vein; tumour thrombus.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/hbsn.2020.03.09). Dr. ACYC and Dr. CML serve as unpaid editorial board members of Hepatobiliary Surgery and Nutrition. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Comparison of disease free survival between LT and resection group.
Figure 2
Figure 2
Comparison of overall survival between LT and resection group.
Figure 3
Figure 3
Comparison of overall survival between LT and resection group in matched population (AFP <500 ng/mL).
See this image and copyright information in PMC

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