Poorly differentiated hepatocellular carcinoma: resection is equivalent to transplantation in patients with low liver fibrosis |
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| Affiliation: | 1. Department of Surgery, St. Elizabeth''s Medical Center, Tufts University School of Medicine, Boston, MA, USA;2. Department of Surgery, University of Miami Health System, Miller School of Medicine, Miami, FL, USA;3. Department of Surgery, Division of Transplant and Hepatobiliary Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA;4. Department of Occupational Therapy and Community Health, Tufts University, Boston, MA, USA;5. Department of Medical Oncology, Dana-Farber Cancer Institute at St. Elizabeth''s Medical Center, Harvard Medical School, Boston, MA, USA;1. Department of General Surgery, Osan Hankook Hospital, 16, MilMeori-Ro 1 Beon-Gil, Osan-si, Gyeonggi-do, 18144, Republic of Korea;2. Biostatistics Collaboration Team, Research Core, Research Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10408, Republic of Korea;3. Center for Liver & Pancreato-biliary Cancer, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10408, Republic of Korea;4. Department of Anesthesiology and Pain Medicine, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10408, Republic of Korea;1. Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA;2. Department of Surgery, Division of Surgical Oncology, University of Cincinnati College of Medicine, Cincinnati, OH, USA;1. Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Japan;2. Department of Hepatobiliary-Pancreatic Surgery, Juntendo University School of Medicine, Japan;3. Department of Hepatobiliary and Pancreatic Surgery, The Cancer Institute Hospital, Japan;4. Department of Surgery, National Defense Medical College, Japan;5. Department of Medical Oncology, Toranomon Hospital, Japan;6. Department of Digestive Surgery, Nihon University School of Medicine, Japan;7. Department of Surgery, NTT Medical Center Tokyo, Japan;8. Department of Surgery, National Center for Global-Health and Medicine, Japan;1. Department of General, Visceral, and Transplantation Surgery, University Hospital of RWTH Aachen, Aachen, Germany;2. Department of Surgery, Maastricht University Medical Center (MUMC), Maastricht, the Netherlands;3. Institute of Pathology, University Hospital RWTH Aachen, Aachen, Germany;4. NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands;5. Department of Internal Medicine, Division of Medical Oncology, GROW – School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands;6. Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands;1. Mount Sinai Medical Center NY, RMTI, Transplantation, NY, NY, USA;2. Division of Gastroenterology and Hepatology, Beth Israel, Deaconess Medical Center, Harvard Medical School, Boston, MA, USA;1. Department of Surgery, Washington University in St Louis, St Louis, MO, USA;2. Barnes-Jewish Hospital, St Louis, MO, USA;3. University College Dublin School of Medicine, Ireland |
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| Abstract: | BackgroundOrgan allocation criteria for liver transplantation focus on tumor size and multifocality while tumor differentiation and existing liver damage are omitted. This study analyzes the impact of hepatocellular carcinoma (HCC) grade and liver fibrosis comparing resection (SX) to transplantation (LT).MethodsThe National Cancer Database was queried between 2004 and 2016 for solitary HCC meeting Milan criteria undergoing SX vs LT. Two groups were created: low fibrosis (LF) vs high fibrosis (HF) and stratified by grade. Cox multivariable regression models, Kaplan–Meier survival analyses and log-rank tests were performed.Results1515 patients were identified; 780 had LT and 735 had SX. Median overall survival (mOS) was 39.7 months; LT mOS was 47.9 months vs SX mOS of 34.9 months (P < .001). Multivariate analysis revealed SX, no chemotherapy, longer hospital stays, and age to be associated with worse survival. However, while transplantation conferred survival benefit for well-moderately differentiated tumors, SX vs LT did not impact survival for poorly differentiated HCC in LF patients, independent of tumor size.DiscussionHCC differentiation and liver fibrosis, but not size, synergistically determine efficacy of SX vs LT. Therefore, current HCC transplantation criteria should incorporate tumor grade or liver fibrosis for optimal organ allocation. |
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