Comparison of Long-term Outcome According to Preoperative Clinical Course in Patients Undergone Liver Transplantation for Hepatocellular Carcinoma within Milan Criteria

Kim, Ji Sun; Lee, Kuhn Uk; Shin, Woo Young; Jeon, Young Min; Kim, Tae Hoon; Yi, Nam Joon; Suh, Kyung Suk

Abstract

PURPOSE: We wanted to evaluate the influence of preoperative non-surgical treatment and its duration for hepatocellular carcinoma (HCC) patients who underwent liver transplantation (LT).
METHODS
We analyzed 75 patients with HCC who underwent living donor liver transplantation from January 1999 to December 2005. The median follow-up was 40.2 months. The patients were divided into the not treated group (26 patients) and non-surgically treated group (49 patients). We compared the overall survival (OS) and disease-free survival (DFS) rates of the 24 not treated patients with that of the 33 treated patients within the Milan criteria. The treated group was divided to 39 short-term (<3 years) treated patients and 10 long-term (> or =3 years) treated patients by the preoperative treatment duration. The OS and DFS rates were analyzed.
RESULTS
For 57 patients within the Milan criteria, the 1-, 3- and 5-year OS rates and the 1-, 3- and 5-year DFS rates were 80.0%, 68.5%, 64.8%, 82.0%, 77.2% and 75.1%, respectively. There were no different characteristic between the not treated group and the treated group, except for the mean age and the Child-Turcotte-Pugh score. Compared to the treated group, the OS and DFS rates were slightly better in the not treated group (p=0.053). There were more patients who underwent transcatheter arterial chemoembolization only in the short-term treated group and there were more patients who had microvascular invasion in the long-term treated group. The OS and DFS rates showed no significant difference between the two groups.
CONCLUSION
It is possible that LT is a first treatment for HCC patients. If the patients' response to preoperative treatment was good, then their prognosis may be same regardless of the treatment duration.