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Digestive Diseases and Sciences

, Volume 59, Issue 1, pp 183–191 | Cite as

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

  • Robert J. Wong
  • James Wantuck
  • Antonia Valenzuela
  • Aijaz Ahmed
  • Clark Bonham
  • Amy Gallo
  • Marc L. Melcher
  • Glen Lutchman
  • Waldo Concepcion
  • Carlos Esquivel
  • Gabriel Garcia
  • Tami Daugherty
  • Mindie H. Nguyen
Original Article

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.

Keywords

Liver cancer MELD score OLT Survival Recurrence 

Notes

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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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Robert J. Wong
    • 1
  • James Wantuck
    • 2
  • Antonia Valenzuela
    • 1
  • Aijaz Ahmed
    • 1
  • Clark Bonham
    • 3
  • Amy Gallo
    • 3
  • Marc L. Melcher
    • 3
  • Glen Lutchman
    • 1
  • Waldo Concepcion
    • 3
  • Carlos Esquivel
    • 3
  • Gabriel Garcia
    • 1
  • Tami Daugherty
    • 1
  • Mindie H. Nguyen
    • 1
  1. 1.Liver Transplant Program, Division of Gastroenterology and Hepatology, Department of MedicineStanford University Medical CenterPalo AltoUSA
  2. 2.Department of MedicineStanford University Medical CenterStanfordUSA
  3. 3.Department of SurgeryStanford University Medical CenterStanfordUSA

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