SUMMARY BACKGROUND DATA: Some previous studies demonstrated better survival after transplantation for small hepatocellular carcinoma (HCC) compared with resection, but the influence of differences in tumor invasiveness between transplanted and resected patients has not been studied. This study compared the tumor characteristics of patients with HCC within the Milan criteria treated by resection or transplantation, and elucidated their impact on long-term survival. PATIENTS AND METHODS: Tumor characteristics and long-term survival of 204 cirrhotic patients with resection and 43 cirrhotic patients with transplantation for HCC within the Milan criteria were compared. A multivariate analysis was performed to determine the prognostic factors of survival in all patients with resection or transplantation. RESULTS: Tumors in the transplanted group were associated with lower incidence of high-grade tumors, microscopic venous invasion, and microsatellite nodules. The overall 5-year survival was better in the transplantation group than the resection group (81% vs. 68%, P = 0.017). However, there were no significant differences in survival between the two groups when stratified according to presence or absence of venous invasion. Multivariate analysis showed that hepatitis C virus serology, tumor size, tumor number, and microscopic venous invasion, but not resection or transplantation, were of prognostic significance. CONCLUSIONS: There were significant differences in tumor invasiveness in HCC treated by transplantation and resection as a result of selection bias, even in patients with the tumors fulfilling the Milan criteria. When the different tumor invasiveness was taken into account, there was no significant difference in the long-term survival after resection or transplantation.
SUMMARY BACKGROUND DATA: Some previous studies demonstrated better survival after transplantation for small hepatocellular carcinoma (HCC) compared with resection, but the influence of differences in tumor invasiveness between transplanted and resected patients has not been studied. This study compared the tumor characteristics of patients with HCC within the Milan criteria treated by resection or transplantation, and elucidated their impact on long-term survival. PATIENTS AND METHODS: Tumor characteristics and long-term survival of 204 cirrhotic patients with resection and 43 cirrhotic patients with transplantation for HCC within the Milan criteria were compared. A multivariate analysis was performed to determine the prognostic factors of survival in all patients with resection or transplantation. RESULTS:Tumors in the transplanted group were associated with lower incidence of high-grade tumors, microscopic venous invasion, and microsatellite nodules. The overall 5-year survival was better in the transplantation group than the resection group (81% vs. 68%, P = 0.017). However, there were no significant differences in survival between the two groups when stratified according to presence or absence of venous invasion. Multivariate analysis showed that hepatitis C virus serology, tumor size, tumor number, and microscopic venous invasion, but not resection or transplantation, were of prognostic significance. CONCLUSIONS: There were significant differences in tumor invasiveness in HCC treated by transplantation and resection as a result of selection bias, even in patients with the tumors fulfilling the Milan criteria. When the different tumor invasiveness was taken into account, there was no significant difference in the long-term survival after resection or transplantation.
Authors: Charles H Cha; Leyo Ruo; Yuman Fong; William R Jarnagin; Jinru Shia; Leslie H Blumgart; Ronald P DeMatteo Journal: Ann Surg Date: 2003-09 Impact factor: 12.969
Authors: Francis Y Yao; Nathan M Bass; Bev Nikolai; Timothy J Davern; Robert Kerlan; Victor Wu; Nancy L Ascher; John P Roberts Journal: Liver Transpl Date: 2002-10 Impact factor: 5.799
Authors: Jean-Marc Bigourdan; Daniel Jaeck; Nicolas Meyer; Carole Meyer; Elie Oussoultzoglou; Philippe Bachellier; Jean-Christophe Weber; Maxime Audet; Michel Doffoël; Philippe Wolf Journal: Liver Transpl Date: 2003-05 Impact factor: 5.799
Authors: Gabriel E Gondolesi; Sasan Roayaie; Luis Muñoz; Leona Kim-Schluger; Thomas Schiano; Thomas M Fishbein; Sukru Emre; Charles M Miller; Myron E Schwartz Journal: Ann Surg Date: 2004-02 Impact factor: 12.969
Authors: Al B Benson; Thomas A Abrams; Edgar Ben-Josef; P Mark Bloomston; Jean F Botha; Bryan M Clary; Anne Covey; Steven A Curley; Michael I D'Angelica; Rene Davila; William D Ensminger; John F Gibbs; Daniel Laheru; Mokenge P Malafa; Jorge Marrero; Steven G Meranze; Sean J Mulvihill; James O Park; James A Posey; Jasgit Sachdev; Riad Salem; Elin R Sigurdson; Constantinos Sofocleous; Jean-Nicolas Vauthey; Alan P Venook; Laura Williams Goff; Yun Yen; Andrew X Zhu Journal: J Natl Compr Canc Netw Date: 2009-04 Impact factor: 11.908
Authors: Robert J Wong; James Wantuck; Antonia Valenzuela; Aijaz Ahmed; Clark Bonham; Amy Gallo; Marc L Melcher; Glen Lutchman; Waldo Concepcion; Carlos Esquivel; Gabriel Garcia; Tami Daugherty; Mindie H Nguyen Journal: Dig Dis Sci Date: 2013-11-27 Impact factor: 3.199
Authors: Sinziana Dumitra; Salleh I Alabbad; Jeffrey S Barkun; Teodora C Dumitra; Dimitrios Coutsinos; Peter P Metrakos; Mazen Hassanain; Steven Paraskevas; Prosanto Chaudhury; Jean I Tchervenkov Journal: HPB (Oxford) Date: 2013-03-14 Impact factor: 3.647
Authors: Diane K Reyes; Josephina A Vossen; Ihab R Kamel; Nilofer S Azad; Tamara A Wahlin; Michael S Torbenson; Michael A Choti; Jean-Francois H Geschwind Journal: Cancer J Date: 2009 Nov-Dec Impact factor: 3.360
Authors: Wing Chiu Dai; See Ching Chan; Kenneth S H Chok; Tan To Cheung; William W Sharr; Albert C Y Chan; Simon H Y Tsang; James Y Y Fung; Ronnie T P Poon; Sheung Tat Fan; Chung Mau Lo Journal: HPB (Oxford) Date: 2014-01-28 Impact factor: 3.647