Comparative analysis of outcome in patients with hepatocellular carcinoma exceeding the milan criteria treated with liver transplantation versus partial hepatectomy Journal Article
| Authors: | Canter, R. J.; Patel, S. A.; Kennedy, T.; Dangelica, M. I.; Jarnagin, W. R.; Fong, Y.; Blumgart, L. H.; Freeman, R. B.; DeMatteo, R. P.; Abt, P. L. |
| Article Title: | Comparative analysis of outcome in patients with hepatocellular carcinoma exceeding the milan criteria treated with liver transplantation versus partial hepatectomy |
| Abstract: | INTRODUCTION: Proponents of orthotopic liver transplantation (TXP) for the treatment of hepatocellular carcinoma (HCC) advocate expanding the Milan criteria. We performed a matched analysis comparing patients treated with TXP to patients treated with partial hepatectomy (PHX) for HCC exceeding the Milan criteria. METHODS: From the United Network for Organ Sharing registry, we identified 92 US patients with HCC exceeding the Milan criteria who underwent TXP between 2002 and 2005. During the same period, 94 patients with similar tumor size criteria underwent PHX at a single center. Data were analyzed using χ, parametric, nonparametric, and Kaplan-Meier methods. RESULTS: TXP patients were more commonly male (82% vs. 65%, P=0.01) and had a higher Model for End Stage Liver Disease score (median 11 vs. 7, P<0.001). Pathologic cirrhosis (79% TXP vs. 38% PHX, P<0.001), particularly secondary to hepatitis C virus (29% TXP vs. 5% PHX, P<0.001), was more common among TXP patients. Mean cumulative tumor size was 10.0 cm (63% exceeding University of California at San Francisco criteria) among PHX patients compared with 6.4 cm (20% exceeding University of California at San Francisco criteria) for TXP patients (P<0.001). With a median follow-up of 34 months (range, 1-86), 3-year survival was similar between the cohorts (66%±10% for TXP vs. 66%±10% for PHX, P=0.97). Cancer deaths (26/37, 70%) were more prevalent among PHX patients, whereas noncancer deaths (25/37, 68%) were common in TXP patients (P<0.001). CONCLUSIONS: Among heterogeneous patients with HCC who exceed the Milan criteria, TXP and PHX achieve similar overall survival. Further study is needed to ensure appropriate patient selection for these disparate therapies. Copyright © 2011 by Lippincott Williams & Wilkins. |
| Keywords: | cancer survival; treatment outcome; middle aged; cancer surgery; survival rate; major clinical study; overall survival; hepatocellular carcinoma; liver cell carcinoma; liver cirrhosis; liver transplantation; patient selection; carcinoma, hepatocellular; liver neoplasms; cancer staging; follow up; follow-up studies; risk factor; cancer mortality; cause of death; cancer size; scoring system; cancer registry; intermethod comparison; hepatectomy; hepatitis c virus; partial hepatectomy; expanded criteria; criterion variable; milan criterion; model for end stage liver disease score; university of california at san francisco criterion; end stage liver disease |
| Journal Title: | American Journal of Clinical Oncology |
| Volume: | 34 |
| Issue: | 5 |
| ISSN: | 0277-3732 |
| Publisher: | Lippincott Williams & Wilkins |
| Date Published: | 2011-10-01 |
| Start Page: | 466 |
| End Page: | 471 |
| Language: | English |
| DOI: | 10.1097/COC.0b013e3181ec63dd |
| PROVIDER: | scopus |
| PUBMED: | 20938319 |
| DOI/URL: | |
| Notes: | --- - "Export Date: 2 November 2011" - "CODEN: AJCOD" - "Source: Scopus" |
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