Liver transplantation is an alternative treatment of hepatocellular carcinoma beyond the Milan criteria

• Published in: The American journal of surgery 2010-08, Vol.200 (2), p.252-257
• Main Authors: Fan, Hsiu-Lung, M.D, Chen, Teng-Wei, M.D, Hsieh, Chung-Bao, M.D, Jan, Hsiang-Chun, M.D, His, Sheng-Chuan, M.D, De-Chuan, Chan, Chu, Chi-Hong, Ph.D, Yu, Jyh-Cherng, M.D
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular - surgery; Criteria; Data processing; Female; Group dynamics; Hepatectomy; Hepatocellular carcinoma; Humans; Liver; Liver cancer; Liver diseases; Liver Neoplasms - surgery; Liver resection; Liver Transplantation; Liver transplants; Lymphatic system; Male; Medical prognosis; Metastasis; Middle Aged; Milan criteria; Outcome; Patient Selection; Patients; Retrospective Studies; Surgery; Survival; Survival analysis; Tomography; Transplantation; Transplants & implants; Treatment; Treatment Outcome; Tumors; Young Adult
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2009.07.049

Abstract Background The decision to perform liver transplantation (LT) or liver resection (LR) for patients with hepatocellular carcinoma (HCC) who are beyond the Milan criteria remains controversial. Methods We retrospectively analyzed outcome data for 179 patients with HCC beyond the Milan criteria who were treated with LR (n = 135) or LT (n = 44). Univariate and multivariate Cox proportional hazard models were established. Kaplan-Meier survival curves were generated, and a log-rank test was performed to compare group survival status. Results Patients who underwent LR group were significantly older, had a lower TNM stage, and were more likely to have unilateral disease and noncirrhotic liver. Significantly more patients in the LR group had recurrence (53.3% vs 29.5%) or died (61.5% vs 43.2%) than patients in the LT group. Recurrence-free survival rates were 11.9% for the LR group and 61.5% for the LT group. The median overall survival duration showed no statistically difference between the LR group (28.0 months) and the LT group (50.0 months). Conclusions LT may be the better choice for patients with HCC beyond the Milan criteria.