Should we resect or transplant hepatocellular carcinoma beyond UCSF criteria?

Abstract

Introduction: Limited data is available on long-term outcomes after surgical treatment for advanced hepatocellular carcinoma(HCC). The aim of this study was to evaluate the perioperative and long-term outcomes after resection vs. living donor liver transplant(LDLT) for HCC beyond UCSF criteria. Methods: This was a single-center retrospective study from 2000-2018.Data was collected from a prospective maintained dataset. All HCC patients who had tumor stage beyond UCSF criteria were include. Propensity score matching(PSM) at 1:2 was used to adjust for age, tumor number and size between the 2 groups. Results: During study period, 55 and 721 patients underwent LDLT and resection for HCC beyond UCSF. Table 1 showed the patient demographic and tumor stage before/after PSM. There was no difference in hospital mortality(1.8% in LDLT, 0% in resection,p=0.810) but LDLT patients had a higher risk of perioperative complication(38.5 vs. 17%,p=0.048). Despite matching of age, tumor number and size, LDLT patients had better overall and recurrence free survivals.(Figure 1) at 1-, 3- and 5-year(OS: 96.4 vs.80.2%, 79.8 vs.46.4% and 68.7 vs.35.6%) and(RFS: 96.4 vs.37.6%, 78 vs.22.6%, 65.2 vs.19.5%). Conclusion: LDLT offered better OS and RFS for HCC beyond UCSF criteria, and should be offered as a treatment option for advanced HCC.