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Primary Surgical Resection Versus Liver Transplantation for Transplant-Eligible Hepatocellular Carcinoma Patients

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Abstract

Background

Hepatocellular carcinoma (HCC) is a leading cause of mortality worldwide. Existing studies comparing outcomes after liver transplantation (LT) versus surgical resection among transplant-eligible patients are conflicting.

Aim

The purpose of this study was to compare long-term survival between consecutive transplant-eligible HCC patients treated with resection versus LT.

Methods

The present retrospective matched case cohort study compares long-term survival outcomes between consecutive transplant-eligible HCC patients treated with resection versus LT using intention-to-treat (ITT) and as-treated models. Resection patients were matched to LT patients by age, sex, and etiology of HCC in a 1:2 ratio.

Results

The study included 171 patients (57 resection and 114 LT). Resection patients had greater post-treatment tumor recurrence (43.9 vs. 12.9 %, p < 0.001) compared to LT patients. In the as-treated model of the pre-model for end stage liver disease (MELD) era, LT patients had significantly better 5-year survival compared to resection patients (100 vs. 69.5 %, p = 0.04), but no difference was seen in the ITT model. In the multivariate Cox proportional hazards model, inclusive of age, sex, ethnicity, tumor stage, and MELD era (pre-MELD vs. post-MELD), treatment with resection was an independent predictor of poorer survival (HR 2.72; 95 % CI, 1.08–6.86).

Conclusion

Transplant-eligible HCC patients who received LT had significantly better survival than those treated with resection, suggesting that patients who can successfully remain on LT listing and actually undergo LT have better outcomes.

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Acknowledgments

This project was supported in part by an institutional training grant from the National Institutes of Health (NIH) T32DK7056-37 (Wong).

Conflict of interest

None.

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Authors and Affiliations

  1. Liver Transplant Program, Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University Medical Center, 750 Welch Road, Suite 210, Palo Alto, CA, 94304, USA

    Robert J. Wong, Antonia Valenzuela, Aijaz Ahmed, Glen Lutchman, Gabriel Garcia, Tami Daugherty & Mindie H. Nguyen

  2. Department of Medicine, Stanford University Medical Center, 300 Pasteur Drive, Room S102, Stanford, CA, 94305, USA

    James Wantuck

  3. Department of Surgery, Stanford University Medical Center, 750 Welch Rd. #200, Stanford, CA, 94304-5785, USA

    Clark Bonham, Amy Gallo, Marc L. Melcher, Waldo Concepcion & Carlos Esquivel

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  1. Robert J. Wong
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  2. James Wantuck
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  3. Antonia Valenzuela
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  4. Aijaz Ahmed
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  5. Clark Bonham
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  11. Gabriel Garcia
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  13. Mindie H. Nguyen
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Correspondence to Mindie H. Nguyen.

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Wong, R.J., Wantuck, J., Valenzuela, A. et al. Primary Surgical Resection Versus Liver Transplantation for Transplant-Eligible Hepatocellular Carcinoma Patients. Dig Dis Sci 59, 183–191 (2014). https://doi.org/10.1007/s10620-013-2947-8

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  • DOI: https://doi.org/10.1007/s10620-013-2947-8

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