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Time periods affected value of liver transplantation for patients with resectable HCC

The benefits of liver transplantation in patients with hepatocellular carcinoma were better than hepatic resection during a 10-year scenario compared with 5 years, according to an analysis evaluating both procedures in a recent study.

In a multinational study of 1,028 cirrhotic patients with hepatocellular carcinoma (HCC) from one surgical unit in China (n=441) and two in Italy (n=587), researchers calculated a number-needed-to-transplant (NTT). None of the patients had multinodular tumors or those larger than 10 cm, and Child-Turcotte-Pugh only included class A cirrhotic patients.

Using a proportional hazard regression model after hepatic resection (HR), patient survival was compared with liver transplantation (LT). Benefits accounted for nodule quantity (single vs. oligonodular), largest tumor diameter, presence of microscopic vascular invasions (MVI) and time beyond surgery (5 years vs. 10 years). Researchers defined NTT as the “reciprocal of the absolute risk difference between post-LT and post-HR 5-year survival estimations.”

MVI prevalence was observed in 52% of patients within Milan criteria for LT and 71% in those beyond (P<.0001). Nodule size and quantity were positive predictors for transplant benefit in the 5-year survival, while MVI negatively impacted NTT. Without MVI, transplantation was an effective therapy (defined as NTT <5) only for oligonodular HCC no larger than 3 cm.

Researchers said the transplant benefit improved “drastically” for all subgroups of resectable patients in the 10-year scenario. LT was effective for all patients without MVI when there were extended tumors and for oligonodular HCC with MVI that fell within conventional LT criteria.

“The strong impact of MVI on LT benefit and the high prevalence of this aggressive feature also in small tumors undergoing HR suggest that resectable HCC is a contraindication to LT when a 5-year time horizon is adapted,” the investigators concluded. “The 10-year scenario, conversely, increased the transplant benefit in all subgroups of resectable patients, and LT became an effective therapy for all patients without MVI whenever tumor extension and for oligonodular HCC with MVI within conventional LT criteria.”

Disclosure: The researchers report no relevant financial disclosures.