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Multicenter Study
. 2023 Sep 1;107(9):1965-1975.
doi: 10.1097/TP.0000000000004593. Epub 2023 Aug 21.

Surgical Treatment of Hepatocellular Carcinoma: Multicenter Competing-risk Analysis of Tumor-related Death Following Liver Resection and Transplantation Under an Intention-to-treat Perspective

Stefano Di Sandro  1 , Carlo Sposito  2   3 , Matteo Ravaioli  4   5 , Andrea Lauterio  6   7 , Paolo Magistri  1 , Marco Bongini  2 , Federica Odaldi  4 , Riccardo De Carlis  6   8 , Francesca Botta  9 , Leonardo Centonze  6   10 , Lorenzo Maroni  4 , Davide Citterio  2 , Cristiano Guidetti  1 , Vincenzo Bagnardi  9 , Luciano De Carlis  6   7 , Matteo Cescon  4   5 , Vincenzo Mazzaferro  2   3 , Fabrizio Di Benedetto  1 ; HV-HCC-MRT-group
Collaborators, Affiliations
Multicenter Study

Surgical Treatment of Hepatocellular Carcinoma: Multicenter Competing-risk Analysis of Tumor-related Death Following Liver Resection and Transplantation Under an Intention-to-treat Perspective

Stefano Di Sandro et al. Transplantation. .

Abstract

Background: Early-stage hepatocellular carcinoma could benefit from upfront liver resection (LR) or liver transplantation (LT), but the optimal strategy in terms of tumor-related outcomes is still debated. We compared the oncological outcomes of LR and LT for hepatocellular carcinoma, stratifying the study population into a low-, intermediate-, and high-risk class according to the risk of death at 5-y predicted by a previously developed prognostic model. The impact of tumor pathology on oncological outcomes of low- and intermediate-risk patients undergoing LR was investigated as a secondary outcome.

Methods: We performed a retrospective multicentric cohort study involving 2640 patients consecutively treated by LR or LT from 4 tertiary hepatobiliary and transplant centers between 2005 and 2015, focusing on patients amenable to both treatments upfront. Tumor-related survival and overall survival were compared under an intention-to-treat perspective.

Results: We identified 468 LR and 579 LT candidates: 512 LT candidates underwent LT, whereas 68 (11.7%) dropped-out for tumor progression. Ninety-nine high-risk patients were selected from each treatment cohort after propensity score matching. Three and 5-y cumulative incidence of tumor-related death were 29.7% and 39.5% versus 17.2% and 18.3% for LR and LT group ( P = 0.039), respectively. Low-risk and intermediate-risk patients treated by LR and presenting satellite nodules and microvascular invasion had a significantly higher 5-y incidence of tumor-related death (29.2% versus 12.5%; P < 0.001).

Conclusions: High-risk patients showed significantly better intention-to-treat tumor-related survival after upfront LT rather than LR. Cancer-specific survival of low- and intermediate-risk LR patients was significantly impaired by unfavorable pathology, suggesting the application of ab-initio salvage LT in such scenarios.

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Conflict of interest statement

The authors declare no funding or conflicts of interest.

References

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