Survival advantage of primary liver transplantation for resectable hepatocellular carcinoma with vascular invasion within up-to-7 criteria

Abstract

BACKGROUND: Vascular invasion is a poor prognostic factor of liver resection (LR) and liver transplantation (LT) for hepatocellular carcinoma (HCC). Microvascular invasion when demonstrable in the LR specimen is paradoxically considered an indication for LT. METHODS: From July 2000 to June 2009, adult patients who underwent LT and LR as primary treatment for HCC were included. Patients who receieved local ablative therapies before LT, before or during LR were excluded. Patient with neoadjuvant systemic chemotherapy, targeted therapy, with positive resection margins were also excluded. RESULTS: This study included 95 recipients who had LT and 620 patients who underwent LR. Among the LT recipients 81% were within up-to-7 criteria, 77% within UCSF criteria. Slightly over one quarter (26.3%) had HCC with either macro- or micro-vascular invasion. About three-quarter (73.7%) were of living donor liver transplantation. 5-year overall survival of 82% was achieved. Within up-to-7 criteria (n=75), the 5-year survival improved to 85.3%. The presence or absence of vascular invasion had comparable survivals (5-year overall survival, 88.2% vs. 84.7% respectively). Those LT recipients with HCC with vascular invasion had survival comparable to those LR patients with HCC without vascular invasion (88.2% vs. 78.9%, p=0.828) These LR patient had 5-year survivals much better than those with vascular invasion who under LR (47.3%). Thus, the signifi cant survival advantage of LT over LR for HCC with vascular invasi…