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Single HCC in Cirrhotic Patients: Liver Resection or Liver Transplantation? Long-term Outcome According to an Intention-to-treat Basis

Annals of Surgical Oncology volume 20, pages 1194–1202 (2013)Cite this article

ABSTRACT

Background

Compensated cirrhotic patients with single hepatocellular carcinoma (HCC) ≤5 cm may benefit from both liver resection (LR) and liver transplantation (LT); however, the better 10-year actuarial survival of the two treatments remains unclear. We aimed to assess the long-term outcome of cirrhotic patients with single HCC ≤5 cm treated either with LR or LT on an intention-to-treat basis.

Methods

A total of 217 cirrhotic patients with single HCC ≤5 cm were evaluated at our department: 95 were treated with LR (LR group), and 122 were included on the waiting list for LT (LT group). Patients in the LR group were divided into very early HCC (tumor size ≤2 cm) and early HCC (tumor size >2 cm). Median follow-up was 5.3 (range 0.1–18) years.

Results

Tumor recurrence was 72 % in the LR group versus 16 % in the LT group (p < 0.001). 1-, 5-, and 10-year cumulative risk of recurrence was 18, 69, and 83 % in the LR group versus 4, 18, and 20 % in the LT group (p < 0.001). Ten-year actuarial survival was 33 % in the LR group versus 49 % in the LT group (p = 0.002). At HCC recurrence, 27.3 % were included on the waiting list for salvage transplantation (very early HCC group) versus 15.1 % (early HCC group) (p = 0.2). After salvage transplantation, HCC recurrence was 0 % (very early HCC group) versus 40 % (early HCC group) (p = 0.2). No significant differences were observed in 1-, 5-, and 10-year actuarial survival between the very early HCC group and the LT group (95, 55, and 50 % vs. 82, 62, and 50 %).

Conclusions

LR should be the treatment of choice for cirrhotic patients with very early HCC.

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ACKNOWLEDGMENT

We thank Carlos Margarit, MD, PhD, director of the Liver Transplant Unit until 2005. We thank Christine O’Hara for valuable English-language revision. We also thank Esther Delgado.

CONFLICT OF INTEREST

The authors have no conflicts of interest to disclose.

Author information

Affiliations

  1. Department of HBP Surgery and Transplantation, Hospital Universitario Vall d’Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain

    Gonzalo Sapisochin MD, PhD, Cristina Dopazo MD, PhD, Itxarone Bilbao MD, PhD, Jose Luis Lázaro MD, Joaquin Balsells MD, PhD, Mireia Caralt MD & Ramón Charco MD, PhD

  2. Liver Unit, Department of Internal Medicine, Hospital Universitario Vall d’Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain

    Lluis Castells MD, PhD & Beatriz Minguez MD, PhD

  3. Department of Pathology, Hospital Universitario Vall d’Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain

    Helena Allende MD, PhD

  4. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Hospital Universitario Vall d’Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain

    Lluis Castells MD, PhD, Itxarone Bilbao MD, PhD & Beatriz Minguez MD, PhD

Authors
  1. Gonzalo Sapisochin MD, PhD
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  2. Lluis Castells MD, PhD
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  3. Cristina Dopazo MD, PhD
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  4. Itxarone Bilbao MD, PhD
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  7. Helena Allende MD, PhD
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  8. Joaquin Balsells MD, PhD
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  10. Ramón Charco MD, PhD
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Correspondence to Gonzalo Sapisochin MD, PhD.

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Sapisochin, G., Castells, L., Dopazo, C. et al. Single HCC in Cirrhotic Patients: Liver Resection or Liver Transplantation? Long-term Outcome According to an Intention-to-treat Basis. Ann Surg Oncol 20, 1194–1202 (2013). https://doi.org/10.1245/s10434-012-2655-1

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  • DOI: https://doi.org/10.1245/s10434-012-2655-1

Keywords

  • Liver Transplantation
  • Liver Resection
  • Cirrhotic Patient
  • Barcelona Clinic Liver Cancer
  • Cirrhotic Tissue