Long-Term Outcomes After Resection Versus Transplantation for Hepatocellular Carcinoma Within UCSF Criteria

We compared the long-term outcomes of resection and transplantation for hepatocellular carcinoma (HCC) while satisfying the University of California at San Francisco criteria. HCC patients who underwent liver resection (n = 746) and transplantation (n = 54) between 2001 and 2007 were reviewed. Overall and disease-free survival rates were evaluated using the Kaplan-Meier estimator, and independent prognostic factors were determined using the Cox proportional regression model. The presence of cirrhosis was used to divide the patients into groups. The patients who received primary transplantation were further analyzed. Nine years after surgery, the patients' overall survival was similar in the resection and transplantation groups (75.9 and 77.2%, respectively). Furthermore, the recurrence rate in the resection group was higher than that in the transplantation group (65 vs. 34.4%; adjusted hazard ratio, 3.27; range, 1.76-6.08), especially for cirrhosis patients (adjusted hazard ratio, 4.28; range, 2.14-8.56). The results suggested that noncirrhotic patients who underwent resection had a better survival advantage than primary liver transplant recipients did (adjusted hazard ratio, 0.46; range, 0.18-1.21). However, noncirrhotic patients had higher recurrence rates (59.2 vs. 15.8%; adjusted hazard ratio, 3.98; range, 1.26-12.58). Similar trends were noted in patients with hepatitis B virus infection and/or a single tumor. Long-term survival rates after liver transplantation and resection were similar, but the latter was associated with a higher recurrence rate.