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Child-Pugh A Hepatitis B-Related Cirrhotic Patients with a Single Hepatocellular Carcinoma Up to 5 cm: Liver Transplantation vs. Resection

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Objective

This study aims to analyze the outcomes of patients with Child-Pugh A class cirrhosis and a single hepatocellular carcinoma (HCC) up to 5 cm in diameter who underwent liver transplantation vs. resection.

Methods

During 2007 to 2012, 282 Child-Pugh A cirrhotic patients with a single HCC up to 5 cm in diameter either underwent liver resection (N = 243) or received liver transplantation (N = 39) at our center. Patient and tumor characteristics and outcomes were analyzed.

Results

Patients who underwent liver transplantation had a better recurrence-free survival (RFS) vs. those who underwent liver resection. However, the 5-year survival rates after these two treatments were comparable. Similar results were observed when we analyzed patients with a HCC less than 3 cm, and for patients with portal hypertension. In the multivariate analysis, tumor differentiation, difference of primary treatment, and presence of microvascular invasion were associated with postoperative recurrence. However, only differentiation negatively impacted overall survival after operation.

Conclusion

Although more recurrences were observed in Child A cirrhotic patients with a single HCC up to 5 cm after liver resection, liver resection offers a similar 5-year survival to liver transplantation, even for patients with portal hypertension.

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Abbreviations

AFP:

Alpha-fetoprotein

HCC:

Hepatocellular carcinoma

MVI:

Microvascular invasion

NLR:

Neutrophil-to-lymphocyte ratio

OS:

Overall survival

RFS:

Recurrence-free survival

SPH:

Significant portal hypertension

TB:

Total bilirubin

WBC:

White blood cell

References

  1. Llovet JM, Bruix J. Novel advancements in the management of hepatocellular carcinoma in 2008. J Hepatol 2008; 48 Suppl 1: S20–37

    Article  CAS  PubMed  Google Scholar 

  2. Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA: a Cancer Journal for Clinicians 2005; 55(2): 74–108

    Google Scholar 

  3. Jarnagin WR. Management of small hepatocellular carcinoma: a review of transplantation, resection, and ablation. Annals of Surgical Oncology 2010; 17(5): 1226–1233

    Article  PubMed Central  PubMed  Google Scholar 

  4. Mazzaferro V, Regalia E, Doci R, Andreola S, Pulvirenti A, Bozzetti F, Montalto F, Ammatuna M, Morabito A, Gennari L. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. The New England Journal of Medicine 1996; 334(11): 693–699

    Article  CAS  PubMed  Google Scholar 

  5. Doyle MB, Vachharajani N, Maynard E, Shenoy S, Anderson C, Wellen JR, Lowell JA, Chapman WC. Liver transplantation for hepatocellular carcinoma: long-term results suggest excellent outcomes. Journal of the American College of Surgeons 2012; 215(1): 19–28; discussion 28–30

    Article  PubMed  Google Scholar 

  6. Bhangui P, Vibert E, Majno P, Salloum C, Andreani P, Zocrato J, Ichai P, Saliba F, Adam R, Castaing D, Azoulay D. Intention-to-treat analysis of liver transplantation for hepatocellular carcinoma: living versus deceased donor transplantation. Hepatology 2011; 53(5): 1570–1579

    Article  PubMed  Google Scholar 

  7. Choi GH, Park JY, Hwang HK, Kim DH, Kang CM, Choi JS, Park YN, Kim do Y, Ahn SH, Han KH, Chon CY, Lee WJ. Predictive factors for long-term survival in patients with clinically significant portal hypertension following resection of hepatocellular carcinoma. Liver Int 2011; 31(4): 485–493

    Article  CAS  PubMed  Google Scholar 

  8. Giuliante F, Ardito F, Pinna AD, Sarno G, Giulini SM, Ercolani G, Portolani N, Torzilli G, Donadon M, Aldrighetti L, Pulitano C, Guglielmi A, Ruzzenente A, Capussotti L, Ferrero A, Calise F, Scuderi V, Federico B, Nuzzo G. Liver resection for hepatocellular carcinoma </=3 cm: results of an Italian multicenter study on 588 patients. Journal of the American College of Surgeons 2012; 215(2): 244–254

    Article  PubMed  Google Scholar 

  9. Bruix J, Sherman M, American Association for the Study of Liver D. Management of hepatocellular carcinoma: an update. Hepatology 2011; 53(3): 1020–1022

    Article  PubMed Central  PubMed  Google Scholar 

  10. Bruix J, Sherman M, Llovet JM, Beaugrand M, Lencioni R, Burroughs AK, Christensen E, Pagliaro L, Colombo M, Rodes J, HCC EPoEo. Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL conference. European Association for the Study of the Liver. J Hepatol 2001; 35(3): 421–430

    Article  CAS  PubMed  Google Scholar 

  11. Li C, Wen TF, Yan LN, Li B, Yang JY, Wang WT, Xu MQ, Wei YG. Outcome of hepatocellular carcinoma treated by liver transplantation: comparison of living donor and deceased donor transplantation. Hepatobiliary Pancreat Dis Int 2010; 9(4): 366–369

    PubMed  Google Scholar 

  12. Llovet JM, Bru C, Bruix J. Prognosis of hepatocellular carcinoma: the BCLC staging classification. Seminars in Liver Disease 1999; 19(3): 329–338

    Article  CAS  PubMed  Google Scholar 

  13. Ishizawa T, Hasegawa K, Aoki T, Takahashi M, Inoue Y, Sano K, Imamura H, Sugawara Y, Kokudo N, Makuuchi M. Neither multiple tumors nor portal hypertension are surgical contraindications for hepatocellular carcinoma. Gastroenterology 2008; 134(7): 1908–1916

    Article  PubMed  Google Scholar 

  14. Yeo W, Mo FK, Chan SL, Leung NW, Hui P, Lam WY, Mok TS, Lam KC, Ho WM, Koh J, Tang JW, Chan AT, Chan PK. Hepatitis B viral load predicts survival of HCC patients undergoing systemic chemotherapy. Hepatology 2007; 45(6): 1382–1389

    Article  CAS  PubMed  Google Scholar 

  15. Yu MW, Yeh SH, Chen PJ, Liaw YF, Lin CL, Liu CJ, Shih WL, Kao JH, Chen DS, Chen CJ. Hepatitis B virus genotype and DNA level and hepatocellular carcinoma: a prospective study in men. Journal of the National Cancer Institute 2005; 97(4): 265–272

    Article  CAS  PubMed  Google Scholar 

  16. Wang GY, Yang Y, Li H, Zhang J, Jiang N, Li MR, Zhu HB, Zhang Q, Chen GH. A scoring model based on neutrophil to lymphocyte ratio predicts recurrence of HBV-associated hepatocellular carcinoma after liver transplantation. PloS One 2011; 6(9): e25295

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  17. Fan ST, Poon RT, Yeung C, Lam CM, Lo CM, Yuen WK, Ng KK, Liu CL, Chan SC. Outcome after partial hepatectomy for hepatocellular cancer within the Milan criteria. The British Journal of Surgery 2011; 98(9): 1292–1300

    Article  CAS  PubMed  Google Scholar 

  18. Hung HH, Lei HJ, Chau GY, Su CW, Hsia CY, Kao WY, Lui WY, Wu WC, Lin HC, Wu JC. Milan criteria, multi-nodularity, and microvascular invasion predict the recurrence patterns of hepatocellular carcinoma after resection. Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract 2013; 17(4): 702–711

    Article  Google Scholar 

  19. Toso C, Trotter J, Wei A, Bigam DL, Shah S, Lancaster J, Grant DR, Greig PD, Shapiro AM, Kneteman NM. Total tumor volume predicts risk of recurrence following liver transplantation in patients with hepatocellular carcinoma. Liver Transpl 2008; 14(8): 1107–1115

    Article  PubMed  Google Scholar 

  20. Mazzaferro V, Llovet JM, Miceli R, Bhoori S, Schiavo M, Mariani L, Camerini T, Roayaie S, Schwartz ME, Grazi GL, Adam R, Neuhaus P, Salizzoni M, Bruix J, Forner A, De Carlis L, Cillo U, Burroughs AK, Troisi R, Rossi M, Gerunda GE, Lerut J, Belghiti J, Boin I, Gugenheim J, Rochling F, Van Hoek B, Majno P, Metroticket Investigator Study G. Predicting survival after liver transplantation in patients with hepatocellular carcinoma beyond the Milan criteria: a retrospective, exploratory analysis. The Lancet Oncology 2009; 10(1): 35–43

    Article  PubMed  Google Scholar 

  21. Earl TM, Chapman WC. Hepatocellular Carcinoma: resection versus transplantation. Seminars in Liver Disease 2013; 33(3): 282–292

    Article  PubMed  Google Scholar 

  22. Baccarani U, Isola M, Adani GL, Benzoni E, Avellini C, Lorenzin D, Bresadola F, Uzzau A, Risaliti A, Beltrami AP, Soldano F, De Anna D, Bresadola V. Superiority of transplantation versus resection for the treatment of small hepatocellular carcinoma. Transplant International: Official Journal of the European Society for Organ Transplantation 2008; 21(3): 247–254

    Article  Google Scholar 

  23. Bigourdan JM, Jaeck D, Meyer N, Meyer C, Oussoultzoglou E, Bachellier P, Weber JC, Audet M, Doffoel M, Wolf P. Small hepatocellular carcinoma in Child A cirrhotic patients: hepatic resection versus transplantation. Liver Transpl 2003; 9(5): 513–520

    Article  PubMed  Google Scholar 

  24. Rahman A, Assifi MM, Pedroso FE, Maley WR, Sola JE, Lavu H, Winter JM, Yeo CJ, Koniaris LG. Is resection equivalent to transplantation for early cirrhotic patients with hepatocellular carcinoma? A meta-analysis. Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract 2012; 16(10): 1897–1909

    Article  Google Scholar 

  25. Hernandez-Gea V, Turon F, Berzigotti A, Villanueva A. Management of small hepatocellular carcinoma in cirrhosis: focus on portal hypertension. World J Gastroenterol 2013; 19(8): 1193–1199

    Article  PubMed Central  PubMed  Google Scholar 

  26. Capussotti L, Ferrero A, Vigano L, Polastri R, Tabone M. Liver resection for HCC with cirrhosis: surgical perspectives out of EASL/AASLD guidelines. European Journal of Surgical Oncology: the Journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology 2009; 35(1): 1–15

    Article  Google Scholar 

  27. Bruix J, Castells A, Bosch J, Feu F, Fuster J, Garcia-Pagan JC, Visa J, Bru C, Rodes J. Surgical resection of hepatocellular carcinoma in cirrhotic patients: prognostic value of preoperative portal pressure. Gastroenterology 1996; 111(4): 1018–1022

    Article  CAS  PubMed  Google Scholar 

  28. Chen XP, Wu ZD, Huang ZY, Qiu FZ. Use of hepatectomy and splenectomy to treat hepatocellular carcinoma with cirrhotic hypersplenism. The British Journal of Surgery 2005; 92(3): 334–339 [PMID: 15672441

    Article  PubMed  Google Scholar 

  29. Adam R, Bhangui P, Vibert E, Azoulay D, Pelletier G, Duclos-Vallee JC, Samuel D, Guettier C, Castaing D. Resection or transplantation for early hepatocellular carcinoma in a cirrhotic liver: does size define the best oncological strategy? Ann Surg 2012; 256(6): 883–891

    Article  PubMed  Google Scholar 

  30. Massie AB, Caffo B, Gentry SE, Hall EC, Axelrod DA, Lentine KL, Schnitzler MA, Gheorghian A, Salvalaggio PR, Segev DL. MELD Exceptions and Rates of Waiting List Outcomes. Am J Transplant 2011; 11(11): 2362–2371

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  31. Kow AW, Kwon CH, Song S, Shin M, Kim JM, Joh JW. Risk factors of peritoneal recurrence and outcome of resected peritoneal recurrence after liver resection in hepatocellular carcinoma: review of 1222 cases of hepatectomy in a tertiary institution. Annals of Surgical Oncology 2012; 19(7): 2246–2255

    Article  PubMed Central  PubMed  Google Scholar 

  32. Yip VS, Gomez D, Tan CY, Staettner S, Terlizzo M, Fenwick S, Malik HZ, Ghaneh P, Poston G. Tumour size and differentiation predict survival after liver resection for hepatocellular carcinoma arising from non-cirrhotic and non-fibrotic liver: a case-controlled study. International Journal of Surgery 2013; 11:1078-82

    Article  CAS  PubMed  Google Scholar 

  33. Zhou YM, Yang JM, Li B, Yin ZF, Xu F, Wang B, Xu W, Kan T. Risk factors for early recurrence of small hepatocellular carcinoma after curative resection. Hepatobiliary Pancreat Dis Int 2010; 9(1): 33–37

    PubMed  Google Scholar 

  34. Yaprak O, Akyildiz M, Dayangac M, Demirbas BT, Guler N, Dogusoy GB, Yuzer Y, Tokat Y. AFP level and histologic differentiation predict the survival of patients with liver transplantation for hepatocellular carcinoma. Hepatobiliary Pancreat Dis Int 2012; 11(3): 256–261

    Article  PubMed  Google Scholar 

  35. Zheng SS, Xu X, Wu J, Chen J, Wang WL, Zhang M, Liang TB, Wu LM. Liver transplantation for hepatocellular carcinoma: Hangzhou experiences. Transplantation 2008; 85(12): 1726–1732

    Article  CAS  PubMed  Google Scholar 

  36. Shah SA, Tan JC, McGilvray ID, Cattral MS, Levy GA, Greig PD, Grant DR. Does microvascular invasion affect outcomes after liver transplantation for HCC? A histopathological analysis of 155 consecutive explants. Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract 2007; 11(4): 464–471

    Article  Google Scholar 

  37. Ataide EC, Boin IF, Almeida JR, Seva-Pereira T, Stucchi RS, Cardoso AR, Caruy CA, Escanhoela CA. Prognostic factors for hepatocellular carcinoma recurrence: experience with 83 liver transplantation patients. Transplantation Proceedings 2011; 43(4): 1362–1364

    Article  CAS  PubMed  Google Scholar 

  38. Roayaie S, Blume IN, Thung SN, Guido M, Fiel MI, Hiotis S, Labow DM, Llovet JM, Schwartz ME. A system of classifying microvascular invasion to predict outcome after resection in patients with hepatocellular carcinoma. Gastroenterology 2009; 137(3): 850–855

    Article  PubMed Central  PubMed  Google Scholar 

  39. Sumie S, Kuromatsu R, Okuda K, Ando E, Takata A, Fukushima N, Watanabe Y, Kojiro M, Sata M. Microvascular invasion in patients with hepatocellular carcinoma and its predictable clinicopathological factors. Annals of Surgical Oncology 2008; 15(5): 1375–1382

    Article  PubMed  Google Scholar 

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Acknowledgment

This work was supported by a grant from the National Science and Technology Major Project of China (2012ZX 10002-016 and 2012ZX10002-017).

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Authors and Affiliations

  1. Division of Liver Surgery and Liver Transplantation, West China Hospital of Sichuan University, Chengdu, 610041, China

    Chuan Li, Wen-Jiang Zhu, Tian-Fu Wen, Lu-Nan Yan, Bo Li, Jia-Yin Yang, Wen-Tao Wang & Ming-Qing Xu

  2. Day Surgery Center, West China Hospital of Sichuan University, Chengdu, 610041, China

    Yan Dai

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  1. Chuan Li
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Correspondence to Tian-Fu Wen or Yan Dai.

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Li, C., Zhu, WJ., Wen, TF. et al. Child-Pugh A Hepatitis B-Related Cirrhotic Patients with a Single Hepatocellular Carcinoma Up to 5 cm: Liver Transplantation vs. Resection. J Gastrointest Surg 18, 1469–1476 (2014). https://doi.org/10.1007/s11605-014-2550-0

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  • DOI: https://doi.org/10.1007/s11605-014-2550-0

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