Premium
Hepatocellular carcinoma in Child's A cirrhosis: a retrospective analysis of matched pairs following liver transplantation vs. liver resection according to the intention‐to‐treat principle
Author(s) -
Foltys Daniel,
Zimmermann Tim,
Kaths Moritz,
Strempel Mari,
Heise Michael,
HoppeLotichius Maria,
Weiler Nina,
Scheuermann Uwe,
Ruckes Christian,
Hansen Torsten,
Pitton Michael,
Otto Gerd
Publication year - 2014
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.12273
Subject(s) - medicine , cirrhosis , hepatocellular carcinoma , liver transplantation , milan criteria , transplantation , carcinoma , gastroenterology , retrospective cohort study , survival rate , resection , surgery
This is the first matched pair analysis on the puzzling clinical problem of whether to perform liver transplantation ( LT ) or liver resection ( LR ) for Child's A hepatocellular carcinoma ( HCC ) patients. A total of 201 patients diagnosed with HCC and Child's A liver cirrhosis were treated with LT transarterial chemoembolization ( TACE ) or LR between 1998 and 2012. To achieve the most accurate study design, two groups of 57 patients were matched retrospectively according to their tumor characteristics detected by the initial computerized tomography ( CT ) scan. Sixteen of 57 LT candidates were not transplanted due to tumor progress during pre‐treatment ( TACE ). Nevertheless, the retrospective analysis of the matched pairs according to the intention‐to‐treat principle resulted in a better five‐yr overall survival ( OS ) rate of 54.3% for the group of LT candidates compared with 35.7% for those receiving LR (p = 0.19). In patients meeting the University of California, San Francisco ( UCSF ) criteria, five‐yr OS reached 58.4% after LT and 45.1% after LR (p = 0.56). For Milan criteria ( MC ) patients, LT resulted in 57.9% and LR in 42% five‐yr OS rate (p = 0.29). In conclusion, the finding of a better OS rate in LT was not statistically significant. There was also a selection bias in favor of LT , which may have influenced the OS . Therefore, particularly in regard to organ scarcity, LR remains a viable treatment option for respectable HCC in Child's A cirrhosis.