Survival and Recurrence After Liver Transplantation Versus Liver Resection for Hepatocellular Carcinoma

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Abstract
This study compares the results of liver transplantation (LTx) and liver resection (LR) for hepatocellular carcinoma (HCC) to test the widespread hypothesis that LTx is the preferable approach for small HCCs. With respect to scarcity of donor organs and poor results, LTxs for large HCCs are obsolete. Small HCC transplantations have been reported to result in an excellent survival rate. However, the data of comparative studies are controversial. Patients who were treated curatively by LTx (n = 50) or LR (n = 52) for HCC were included in this retrospective study. Survival and freedom from recurrence were analyzed. Patients were stratified according to prognostic factors (pT classification, tumor size, number of tumor nodules, vascular infiltration, and cirrhosis). Overall, after LTx and LR the 3-year survival rate and recurrence rate were not significantly different. In the Cox analysis, tumor size (p = 0.02) and vascular infiltration (p = 0.04) were independent variables after LTx, whereas after LR, none of the tested prognostic parameters was significant. With regards to recurrence, tumor size was the only independent factor, after both LTx and LR (p = 0.02, respectively). Directly comparing the two therapeutic approaches, a 3-year survival rate in pT 1/2, oligocentric (1-5 nodules), and oligocentric and small tumors proved to be superior after LTx. The recurrence rate after LTx was superior to LR in pT 1/2 and oligocentric tumors. Remarkably, for small (≤5 cm) tumors, LTx and LR resulted in a similar 3-year survival rate and freedom from recurrence. According to our analysis, the oncological advantage of LTx compared with LR is questionable. This applies especially for small tumors. Superior results of LTx in early stage HCC and particularly in oligocentric tumors may be attributed to incorrect preoperative diagnosis. Nevertheless, LTx is a reasonable treatment for patients with early stage tumors if a LR is impossible because of tumor localization or poor functional hepatic capacity.