Liver transplant offers a survival benefit over margin negative resection in patients with small unifocal hepatocellular carcinoma and preserved liver function.

Abstract

BACKGROUND:

Studies comparing orthotopic liver transplantation to margin negative resection for patients with small unifocal hepatocellular carcinoma have not controlled for degree of cirrhosis.

METHODS:

The National Cancer Database was used to identify patients with preserved liver function (Model for End-stage Liver Disease score ≤12) who underwent orthotopic liver transplantation or margin negative resection for American Joint Committee on Cancer stage I hepatocellular carcinoma lesions <3 cm between 2010 and 2013. Multivariable and Cox regression adjusting for age, demographics, comorbid disease burden, Model for End-stage Liver Disease score, tumor size, and operation were used to compare overall survival between cohorts.

RESULTS:

In the study, 241 (53%) patients underwent orthotopic liver transplantation. In addition, 219 (47%) underwent margin negative resection. On multivariable regression, patients having a Charlson comorbidity score ≥2 were more likely to undergo orthotopic liver transplantation, (odds ratio 1.94, P=.03). African American patients (odds ratio 0.44, P=.02), and patients of advanced age (odds ratio 0.92, P<.001) were more likely to undergo margin negative resection. Patients undergoing orthotopic liver transplantation had longer overall survival than those undergoing margin negative resection (median OS not reached versus 67.6 months, P<.001). Multivariable Cox regression identified surgical procedure as the only independent determinant of survival with margin negative resection conferring a nearly 3-fold increased risk of death (hazard ratio 2.86, P<.001).

CONCLUSION:

Orthotopic liver transplantation offers a survival advantage relative to margin negative resection for patients with small unifocal hepatocellular carcinoma and preserved liver function.

• Authors: Andrew J Benjamin, Talia B Baker, Mark S Talamonti, Adam S Bodzin, Andrew B Schneider, David J Winschester, Kevin K Roggin, David J Bentrem, Nicholas R Suss, Marshall S Baker
• Journal: Surgery (Surgery) Vol. 163 Issue 3 Pg. 582-586 (03 2018) ISSN: 1532-7361 [Electronic] United States
• PMID: 29370929 (Publication Type: Journal Article)
• Copyright: Copyright © 2017 Elsevier Inc. All rights reserved.

Topics

• Aged
• Carcinoma, Hepatocellular (mortality, pathology, surgery)
• Female
• Hepatectomy
• Humans
• Liver Neoplasms (mortality, pathology, surgery)
• Liver Transplantation
• Male
• Margins of Excision
• Middle Aged
• Neoplasm Staging
• Retrospective Studies
• Survival Rate
• Treatment Outcome