Liver resection versus liver transplantation for hepatocellular carcinoma within the Milan criteria based on estimated microvascular invasion risks

Author:

Yang Pinghua1,Teng Fei2,Bai Shilei1,Xia Yong1,Xie Zhihao1,Cheng Zhangjun13,Li Jun1,Lei Zhengqing13,Wang Kui4,Zhang Baohua5,Yang Tian4ORCID,Wan Xuying6,Yin Hao2,Shen Hao1,Pawlik Timothy M7ORCID,Lau Wan Yee18,Fu Zhiren2,Shen Feng1ORCID

Affiliation:

1. Department of Hepatic Surgery IV and Clinical Research Institute, The Eastern Hepatobiliary Surgery Hospital, Naval Medical University , Shanghai, P. R. China

2. Department of Liver Surgery and Organ Transplantation, The Changzheng Hospital, Naval Medical University , Shanghai, P. R. China

3. Department of General Surgery, The Affiliated Zhongda Hospital, Southeast University , Nanjing, Jiangsu, P. R. China

4. Department of Hepatic Surgery II and Clinical Research Institute, The Eastern Hepatobiliary Surgery Hospital, Naval Medical University , Shanghai, P. R. China

5. Department of Biliary Surgery IV and Clinical Research Institute, The Eastern Hepatobiliary Surgery Hospital, Naval Medical University , Shanghai, P. R. China

6. Department of Chinese Traditional Medicine, The Eastern Hepatobiliary Surgery Hospital, Naval Medical University , Shanghai, P. R. China

7. Department of Surgery, The Wexner Medical Center, Ohio State University , Columbus, OH, USA

8. Faculty of Medicine, the Chinese University of Hong Kong, Prince of Wales Hospital , Shatin, New Territories, Hong Kong SAR, China

Abstract

Abstract Background Preoperative prediction of microvascular invasion (MVI) in hepatocellular carcinoma (HCC) may optimize individualized treatment decision-making. This study aimed to investigate the prognostic differences between HCC patients undergoing liver resection (LR) and liver transplantation (LT) based on predicted MVI risks. Methods We analysed 905 patients who underwent LR, including 524 who underwent anatomical resection (AR) and 117 who underwent LT for HCC within the Milan criteria using propensity score matching. A nomogram model was used to predict preoperative MVI risk. Results The concordance indices of the nomogram for predicting MVI were 0.809 and 0.838 in patients undergoing LR and LT, respectively. Based on an optimal cut-off value of 200 points, the nomogram defined patients as high- or low-risk MVI groups. LT resulted in a lower 5-year recurrence rate and higher 5-year overall survival (OS) rate than LR among the high-risk patients (23.6% vs 73.2%, P < 0.001; 87.8% vs 48.1%, P < 0.001) and low-risk patients (19.0% vs 45.7%, P < 0.001; 86.5% vs 70.0%, P = 0.002). The hazard ratios (HRs) of LT vs LR for recurrence and OS were 0.18 (95% confidence interval [CI], 0.09–0.37) and 0.12 (95% CI, 0.04–0.37) among the high-risk patients and 0.37 (95% CI, 0.21–0.66) and 0.36 (95% CI, 0.17–0.78) among the low-risk patients. LT also provided a lower 5-year recurrence rate and higher 5-year OS rate than AR among the high-risk patients (24.8% vs 63.5%, P = 0.001; 86.7% vs 65.7%, P = 0.004), with HRs of LT vs AR for recurrence and OS being 0.24 (95% CI, 0.11–0.53) and 0.17 (95% CI, 0.06–0.52), respectively. The 5-year recurrence and OS rates between patients undergoing LT and AR were not significantly different in the low-risk patients (19.4% vs 28.3%, P = 0.129; 85.7% vs 77.8%, P = 0.161). Conclusions LT was superior to LR for patients with HCC within the Milan criteria with a predicted high or low risk of MVI. No significant differences in prognosis were found between LT and AR in patients with a low risk of MVI.

Funder

State Key Project on Infectious Diseases

Publisher

Oxford University Press (OUP)

Subject

Gastroenterology

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