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Transplantation for HCC Improves Progression Free Survival but Not Overall Survival When Compared to Resection
Rafael Pieretti- Vanmarcke*1,2, Hui Zheng3,2, Nahel Elias1,2, David L. Berger1,2, Kenneth Tanabe1,2, Keith D. Lillemoe1,2, Cristina R. Ferrone1,2
1Department of Surgery, Massachusetts General Hospital, Boston, MA; 2Harvard Medical School, Boston, MA; 3Biostatistics, Massachusetts General Hospital, Boston, MA
Objective: To compare the outcomes of patients with hepatocellular carcinoma (HCC) undergoing either liver transplantation(LT) or resection(LR).
Methods: A single institution retrospective analysis of 327 HCC patients treated between 8/1991-12/2011.
Results: A total of 327 patients with HCC underwent surgical treatment of whom 79% were male, 19% had hepatitis B and 44% hepatitis C. Patients underwent transplantation (n=138) or surgical resection (n=189). Of the resected patients 126 did not meet the Milan Criteria (MC) while 63 patients were within MC. When comparing resected patients within MC to transplanted patients the median tumor diameter was 3.2 cm and 3.0 cm, respectively. Recurrence rates were 57% for resected patients within MC and 13% for LT patients (P<0.0001). The model end-stage liver disease (MELD) score median was 7 for resected patients within MC and 10 for LT patients. The median overall survival (OS) was 40 months for both resected and transplanted patients. The OS at 1, 3, and 5 years was 47%, 40%, and 23% for resected patients within MC and 59%, 49%, and 33% for transplanted patients. (p=ns). Significant clinicopathologic factors predicting survival were age, size of lesion, lymphovascular invasion, Patients outside of MC who were resected had a significantly decreased survival compared to patients within MC and those who were transplanted.
Conclusions: For HCC patients within Milan criteria, transplantation is associated with a lower recurrence rate, but not a significantly improved overall survival. Patients outside of Milan criteria had a significantly poorer OS when compared to patients within Milan criteria who were resected or transplanted, reflecting a more aggressive disease biology.
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