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Hepatocellular Carcinoma in Transplantable Patients with Well Compensated Cirrhosis: Transplantation Does Not provide a Survival Benefit
*Theodoros Michelakos, *Lei Cai, Nahel Elias, Parsia Vagefi, *Cristina R Ferrone
Massachusetts General Hospital, Boston, MA

Objective: To compare outcomes between hepatectomy and liver transplantation in transplantable hepatocellular carcinoma (HCC) patients with well compensated cirrhosis. Design: Retrospective study. Setting: Tertiary referral center. Patients: Consecutive sample of 251 HCC patients with Child-Pugh class A cirrhosis. Of those, 180 fulfilled the Milan criteria and underwent either liver resection (R-group, N=90) or transplantation (T-group, N=90) between 1993-2015. Interventions:N/A. Main Outcome Measures: Patient characteristics, length-of-stay (LOS), post-operative complications (POC), overall survival (OS), recurrence-free survival (RFS), 3-, 5- and 10-year OS and RFS rates were compared between groups. Results: Transplantation patients were younger (mean age: T-group 59.0+/-6.1y, R-group 63.9+/-11.7y;p=0.001), had a higher MELD score (T-group 9.4+/-4.2, R-group 6.6+/-4.6;p<0.001), and lower platelets (T-group 122+/-57x10³/μL, R-group 182+/-74x10³/μL;p<0.001). Additionally, hepatitis B was more frequent in R-group (T-group:11.2%; R-group:27.0%;p=0.008), while hepatitis C in the T-group (T-group:70.8%; R-group:34.8%;p<0.001). LOS and POC rate were similar between groups (mean LOS: T-group 8.7+/-6.0d; R-group 8.0+/-7.4d; POC rate: T-group 28.4%; R-group 24.4%). OS and 3y, 5y, and 10y OS rates were not-statistically-significantly higher for T-group patients (median OS: T-group 119.7m; R-group 101.8m;p=0.15; 3y, 5y and 10y OS rate: T-group 80%, 80%, 66%; R-group 77%, 62%, 41%, respectively). In contrast, RFS was significantly longer in T-group (median RFS: T-group 119.7m; R-group 33.5m;p<0.001), and 3y, 5y and 10y RFS rates were higher for transplantation patients (3y, 5y and 10y RFS rate: T-group: 93%, 87%, 87%; R-group: 47%, 41%, 29% respectively). In multivariate analysis, only T stage was an independent predictor of survival (p=0.005). Conclusions: Although liver transplantation confers better RFS than resection in Child-Pugh class A transplantable HCC patients, it does not provide an OS benefit. These results may guide optimal treatment of such patients.

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