Operative management is standard treatment of hepatocellular carcinoma (HCC). In select patients, resection can offer cure or a bridge to transplantation. This study analyzed resection exclusive of tumor size, and salvage transplantation.
Patients undergoing liver resection 3/89-9/10 were studied. Patients were not excluded based on tumor size, fibrosis, or liver disease etiology. Patients were stratified: <50, 50-100 and >100 mm. Patients with Child's A, no esophageal varices, and platelets >100×109/L were directed toward resection. Kaplan-Meier and Cox regression were utilized.
313 patients were resected: 36% had tumors <50, 36% 50-100, and 28% had tumors >100 mm. Major hepatectomies comprised 56%, anatomic resections 87%, and 88% were R0. There was an insignificant difference in Clavien grade 3-5 complications among the groups (p=0.78), 16% overall. An 8% in-hospital mortality rate was observed, and declined from 14% (3/89-12/99) to 5% through 9/10 (p=0.008). 1 and 5-year survival was 84% and 67% for those with tumors <50, 75% and 46% for 50-100, and 66% and 34% for >100 mm. However, when 27 patients undergoing salvage transplantation for HCC were excluded, there was no difference (Log-rank<0.19) in survival between the groups. Salvage transplantation occurred in 21%, 8% and 3% of those with tumors <50, 50-10 and >100mm, respectively (p=0.001). 5-year overall survival from the date of recurrence was 91% in the salvage group versus 18% (p=0.0001). On multivariate regression, independent predictors of survival were: operative transfusion (HR=2.6), cirrhosis (HR=2.4), poorly differentiated tumor (HR=2.0), satellite lesions (HR=1.7), microvascular invasion (HR=1.5), AFP >200 (HR=1.5), and salvage transplantation (HR=0.2).
By studying patients with a wide distribution of tumor sizes, we suggest size is not a significant prognostic factor in light of histological data. Although hampered by recurrence rates, resection is safe, offers good survival and may allow for better selection of candidates for early salvage transplantation based on histopathology. The survival benefit seen with resected smaller tumors resulted from salvage transplantation, and patients with non-transplantable recurrences after resection of tumors <50 had similar survival to those originally with tumors >50 mm.
To cite this abstract in AMA style:Kluger M, Salceda J, Laurent A, Tayar C, Azoulay D, Cherqui D. Salvage Transplantation Aligns Survival for Small and Large Hepatocellular Carcinomas in the Modern Era of Liver Surgery [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/salvage-transplantation-aligns-survival-for-small-and-large-hepatocellular-carcinomas-in-the-modern-era-of-liver-surgery/. Accessed November 23, 2020.
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